Capillary Leak Syndrome With Pulmonary Edema Preceded by Organizing Pneumonia Caused by Combination Therapy With Nivolumab and Ipilimumab: A Case Report

Treatment with drugs can cause lung disorders. Immune checkpoint inhibitors are often associated with organizing pneumonia. Capillary leak syndrome is a clinical form of drug-induced lung injury, a rare condition characterized by hemoconcentration, hypoalbuminemia, and hypovolemic shock. There have been no reports of multiple lung injury with immune checkpoint inhibitors, and although capillary leak syndrome alone has been reported in the past, there have been no reports of pulmonary edema as a complication. We report a 68-year-old woman who died of respiratory and circulatory failure owing to pulmonary edema caused by capillary leak syndrome, preceded by organizing pneumonia induced by combination therapy with nivolumab and ipilimumab for postoperative recurrence of lung adenocarcinoma. Residual inflammation and immune abnormalities from previous immune-related pulmonary adverse events may have increased pulmonary capillary permeability, leading to marked pulmonary edema.