Past or ongoing infectious diseases: HIV, Influenza, Mycobacterium Tuberculosis exposure
Smoking, travel and allergens history (including exposure to home occupational aeroallergens)
Discuss previous exposure to thoracic radiotherapy with radiotherapist
Differential Diagnosis
Steroid weaning
Other causes of pneumonia (including atypical pneumonia, Pneumocystis, Tuberculosis, …)
Carcinomatous lymphangitis
Pulmonary oedema
Pulmonary emboli
Sarcoidosis
Steroid considerations
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Grade 2: wean oral steroids over at least 6 weeks, titrate to symptoms
Grade 3/4: wean steroids over at least 8 weeks (evaluate with CT scan)
Caution during steroid treatment:
Calcium & vitamin D supplementation as per local guidelines
Pneumocystis prophylaxis to be considered: Cotrimoxazol 480mg 3 times a week
Restart immunotherapy
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Should be discussed multidisciplinary among oncologist and pneumologist patient should be included in risk assessment (only 7 out 10 cases of pneumonitis had a relaps of pneumonitis upon ICPI restart https://www.ncbi.nlm.nih.gov/pubmed/28798088)
Only indicated once steroids are completely weaned and CT lung is completely cleared