Invasive Aspergillosis in a Patient with Stage III (or 3a or 3b)Non-Small-Cell Lung Cancer Treated with Durvalumab

Durvalumab is a therapeutic monoclonal antibody that blocks the checkpoint inhibitor, programmed death ligand 1 (PD-L1),resulting in T-cell activation and an antitumor response. Durvalumab is approved for patients with unresectable stage III non-small-cell lung cancer (NSCLC) which has not progressed following platinum-based chemoradiotherapy. A 63-year-old manpresented to the emergency department with a 15-day history of increasing shortness of breath. Several months previously, hehad been diagnosed with a poorly differentiated stage IIIB NSCLC. He had completed six cycles of chemotherapy with paclitaxeland carboplatin and four cycles of immunotherapy with durvalumab 13 days before his emergency hospital admission.Computed tomography (CT) imaging showed a large left-sided loculated hydropneumothorax suggestive of empyema, patchyopacification of the left lung, and a left upper lobe lung mass. Histology of the cell block from the pleuralfluid and decorticatedlung tissue showed hyphae suggestive of invasiveAspergillus fumigatus. Treatment with voriconazole resulted in clinicalimprovement. To our knowledge, this is thefirst reported case of pleural aspergillosis in a patient treated with durvalumab.However, the increasing use of immune checkpoint inhibitors in oncology requires increased awareness by clinicians ofimmune-related adverse events (irAEs) due to opportunistic infection