What happened, in summary

A 49-year-old man was diagnosed with metastatic lung adenocarcinoma after malignant pleural fluid was found. Imaging showed cancerous pleural involvement, multiple lung metastases, and nodal disease, supporting Stage IV cancer. He received nivolumab plus ipilimumab and initially had stable disease after the second treatment course. Soon afterward he developed fever, profound inflammation, low blood counts, liver abnormalities, and an extremely high ferritin level. Bone-marrow testing confirmed hemophagocytic lymphohistiocytosis, a rare and potentially life-threatening immune complication. High-dose steroid pulse therapy was started immediately and produced rapid improvement in the blood-count and inflammatory abnormalities. The immune-related HLH did not recur. Despite control of that complication, however, the lung cancer later progressed, and he died from respiratory failure related to the advancing disease.