Differential diagnosis and clinical management of a case of COVID-19 in a stage III lung cancer patient treated with radio-chemotherapy and durvalumab

Background pneumonitis is common in NSCLC and can be a consequence of the disease itself, super-infection, or side effects of the treatment Recently Covid-19 added to the list of possible causes, emerging as a concrete threat for already frail patients Case report a 75-years-old stage-III NSCLC patient underwent radical radio-chemotherapy followed by consolidation durvalumab at our Institution After four cycles, immunotherapy was suspended due to symptomatic pneumonitis responsive to oral steroids Nevertheless, he suddenly developed fever and severe dyspnea Chest radiography described diffuse alveolar and interstitial infiltrates and RT-PCR confirmed the diagnosis of Covid-19 His clinical conditions worsened despite antiviral therapy and supplemental oxygen and the patient died three days after admission Discussion this paper highlights the remarkable clinical and radiological similarity of pneumonitis causated by Covid-19 and immunotherapy, hampering differential diagnosis and corroborating the hypothesis that inflammatory molecules, and possibly PD-L1, play a central role in Covid-19 pathogenesis