Skill Checkup: A 48-Year-Old Triple-Negative Breast Cancer Patient Falls Ill During Immune Checkpoint Inhibitor Therapy

Kelly E. McCann, MD, PhD


May 24, 2022

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.


A 48-year-old woman with metastatic triple-negative breast cancer (TNBC) presents with a new cough, shortness of breath, fever, and fatigue. The cancer is programmed death-ligand 1-positive with a combined positivity score of 15%. She has been on first-line treatment with nabpaclitaxel and pembrolizumab for about 12 weeks. The patient's height and weight are 5 ft 5 in and 151 lb. Blood pressure is 110/70 mm Hg. Oxygen saturation is 95% on room air. Breath sounds are symmetrically decreased on auscultation, and no crackles are heard. The complete blood cell count shows increased white blood cells with a neutrophilic predominance and decreased lymphocytes. CT imaging shows bilateral patchy parenchymal and centrilobular ground-glass opacities without consolidations, effusions, or solid nodules. The day after admission, C-reactive protein increases from 68 mg/dL to 81 mg/dL, and procalcitonin increases from 0.09 ng/mL to 0.36 ng/mL.


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