What happened, in summary

A 63-year-old man with chronic obstructive pulmonary disease was diagnosed with Stage IV squamous cell lung cancer after imaging showed a 60-mm right lower-lobe tumor and extensive lymph-node involvement. He started carboplatin and paclitaxel together with ipilimumab and nivolumab.

Eight days after treatment began, he developed a cough even though chest radiography did not yet show a new abnormality. By day 12, he had a fever and CT showed expanding ground-glass changes in both lungs. He was diagnosed with treatment-related interstitial lung disease.

Prednisolone was started, and both his respiratory symptoms and imaging findings improved. Serial analysis of his breath sounds had shown increasing fine crackles before the lung injury became apparent on imaging, then a rapid decrease after steroid treatment began.