Fatal Postoperative Interstitial Lung Disease after Neoadjuvant Nivolumab and Complete Resection for Non-Small Cell Lung Cancer: A Case Report.

[INTRODUCTION] Neoadjuvant immunotherapy with nivolumab combined with chemotherapy has become a standard treatment for resectable non-small cell lung cancer (NSCLC), demonstrating improved survival outcomes. However, immune checkpoint inhibitors (ICIs) such as nivolumab are associated with immune-related adverse events, including interstitial lung disease (ILD). While ILD is a recognized complication in advanced NSCLC, its occurrence following neoadjuvant ICI therapy and subsequent surgical resection is rarely reported.

[CASE PRESENTATION] An 84-year-old man with stage IIB squamous cell carcinoma of the left lung received three cycles of neoadjuvant chemotherapy with nivolumab, carboplatin, and paclitaxel, followed by left upper lobectomy and mediastinal lymph node dissection. The initial postoperative course was uneventful; however, on POD 7, the patient developed elevated inflammatory markers and radiologic findings suggestive of interstitial changes. Despite the administration of corticosteroids and antibiotics, his condition deteriorated, leading to respiratory failure and death on POD 25. Imaging revealed a diffuse alveolar damage pattern, consistent with severe ILD.

[CONCLUSIONS] This case highlights the potential risk of fatal ILD following neoadjuvant nivolumab therapy and surgical resection in NSCLC patients. Clinicians should maintain a high index of suspicion for ILD in the perioperative period, even in patients without pre-existing pulmonary disease, and consider early diagnostic imaging and timely corticosteroids therapy when appropriate.