Blood Vessel Inflammation After Durvalumab Treatment for Stage III Lung Cancer

What happened, in summary

An 80-year-old woman was diagnosed with stage IIIA, T1N2M0 non-small cell lung cancer of the right upper lobe after a CT scan for exertional breathlessness. She had previously smoked heavily and also lived with heart disease, aortic stenosis, and chronic musculoskeletal pain. Treatment began with carboplatin and paclitaxel chemotherapy and 50 Gy of thoracic radiation delivered over 30 sessions. She then received maintenance durvalumab every 2 weeks for 21 cycles. During the fifth month of durvalumab, worsening breathlessness led to a diagnosis of pneumonitis. Durvalumab was temporarily withheld, and prednisolone starting at 50 mg relieved the respiratory symptoms and joint pains over 6 weeks. She resumed immunotherapy and completed the planned course. Six weeks after the final dose, she developed a painless blue left great toe, painful Raynaud-like symptoms in one hand, fever, a net-like rash on both legs, and recurrent breathlessness. Infection, embolic disease, and common autoimmune causes were investigated without a clear alternative explanation. CT showed residual lung cancer with nearby ground-glass change consistent with pneumonitis. Antibiotics were stopped, and prednisolone was started. Her fever, breathing, kidney function, leg rash, and toe discoloration improved rapidly. Clinicians diagnosed durvalumab-associated vasculitis presenting as blue-toe syndrome. The lung cancer had responded well to treatment, and she was discharged for outpatient follow-up after the immune-related complications improved.