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08 January 2025 : Case report  Japan

Radiological and Pathological Analysis of Pembrolizumab-Associated Lung Lesions: Diagnostic Challenges and Management

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Adverse events of drug therapy, Clinical situation which can not be reproduced for ethical reasons

Tomohito Okano1BDEF, Hajime Fujimoto1ABC, Toshiyuki Ito1BDE, Atsushi Tomaru1BDE, Haruko Saiki1BDE, Tatsuki Tsuruga1ABE, Taro Yasuma23BCD, Corina N. D'Alessandro-Gabazza23CDE, Esteban C. Gabazza ORCID logo123DF*, Tetsu Kobayashi ORCID logo13ABDE

DOI: 10.12659/AJCR.945022

Am J Case Rep 2025; 26:e945022

Table 1. Clinical and laboratory profile of the patient.

ValuesNormal rangeValuesNormal rangeValuesNormal range
White blood cells (/μL)80504,000–11,000Total protein (g/dL)6.76.0–8.3Urine specific gravity1.02
Red blood (cells×10/μL)4.094.1–5.1×10Albumin (g/dL)4.83.4–5.4pH5.5
Hemoglobin (g/dL)14.112–16BUN (mg/dL)216–20Urine protein(–)
Hematocrit (%)40.736–48Creatinine (mg/dL)0.630.59–1.04Urine sugar(–)
Platelets (×10/μL)223150–450eGFR (ml/min/1.73 m)78.790–120Ketone bodies(–)
Neutrophils (%)72.340–60Na (mEq/L)134135–145Occult blood(–)
Lymphocytes (%)18.620–40K (mEq/L)4.73.5–5.2UrobilinogenNormal
Monocytes (%)7.52–8Cl (mEq/L)9796–106Bilirubin(–)
Eosinophils (%)1.20–6Ca (mg/dL)9.48.6–10.2Nitrous acid(–)
Basophils (%)0.40.5–1AST (U/L)218–33Urine WBC(–)
ALT (U/L)134–36ColorStraw
LDH (U/L)185140–280Urine turbidity(–)
HBs antigen(–)γ-GTP (U/L)1013–64SP-A (ng/mL)55.1<43.8
HBs antibody(–)ALP (U/L)5444–147SP-D (ng/mL)198.9<110
HbC antibody(–)T-Bil (mg/dL)0.50.1–1.2KL-6 (U/mL)325<500
HCV antibody(–)T-Chol (mg/dL)382<200RF(–)
RPR(–)TG (mg/dL)149<150MPO-ANCA(–)
TP antibody(–)BS (mg/dL)16070–100PR3-ANCA(–)
HIV antibody(–)HbA1c (%)6.3<5.7ANA(–)
T-SPOT(–)CPK (U/L)15922–198CCP antibody(–)
Coagulation testUA (mg/dL)4.72.6–6.0SSA antibody(–)
APTT (seconds)29.125–35CRP (mg/dL)0.1<0.3Scl70 antibody(–)
PT (seconds)11.210–13IgG antibody (mg/dL)473600–1700ARS antibody(–)
PT-%100.285–100IgA antibody (mg/dL)3870–400sIL-2 receptor(–)
PT-INR10.8–1.1IgM antibody (mg/dL)7940-250Aspergillus Ag(–)
HBs – hepatitis BS; HbC – hepatitis C; HCV – hepatitis C virus; TP – total protein; HIV – human immunodeficiency virus; PT – prothrombin time; PT-INR – prothrombin time-international normalized ratio; BUN – blood urea nitrogen; eGFR – estimated glomerular filtration rate; AST – aspartate aminotransferase; ALT – alanine aminotransferase; LDH – lactate dehydrogenase; GTP – gamma-glutamyl transpeptidase; ALP – alkaline phosphatase; T-Bil – total bilirubin; T-Chol – total cholesterol; TG – triglycerides; BS – blood sugar; HbA1c – hemoglobin A1c; CPK – creatine phosphokinase; UA – uric acid; CRP – C-reactive protein; WBC – white blood cell count; SP-A – surfactant protein A; SP-D – surfactant protein D; KL-6 – krebs von den lungen-6; RF – rheumatoid factor; MPO-ANCA – myeloperoxidase-anti-neutrophil cytoplasmic antibody; PR3-ANCA – proteinase 3-anti-neutrophil cytoplasmic antibody; ANA – antinuclear antibody; CCP – cyclic citrullinated peptide antibody; SSA – Sjögren syndrome-related antigen A; ARS – minoacyltRNA synthetase.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923