RT Journal Article
T1 Case Report: From metabolic normalization to incidental type A aortic dissection in immune checkpoint inhibitor–associated aortitis
A1 Freijido Álvarez, Pablo
A1 León Mateos, Luis Ángel
A1 González García, Nerea
A1 García González, Jorge
A1 Huelga Zapico, Emilio
A1 Garrido Pumar, Miguel
A1 López López, Rafael
K1 Aortic dissection
K1 Aortitis
K1 Case report
K1 Immune checkpoint inhibitors
K1 Immune-related adverse events
K1 Large-vessel vasculitis
K1 Lung adenocarcinoma
AB Immune checkpoint inhibitors can precipitate large-vessel vasculitis. It remains unknown whether metabolic remission on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) reliably indicates long-term structural stability or absence of later complications. A 58-year-old man with KRAS-G12C–mutated stage IVB lung adenocarcinoma initiated first-line treatment with carboplatin + pemetrexed + pembrolizumab. After the fourth cycle he developed persistent fever with normal procalcitonin and negative cultures. Contrast-enhanced computed tomography showed concentric thickening of the aorta and major branches; 18F-FDG PET/CT demonstrated increased inflammatory uptake consistent with large-vessel vasculitis. Testing for autoimmune and infectious etiologies yielded no diagnostic findings. Given the strong clinicoradiologic agreement and the unfavorable risk–benefit profile of deep arterial biopsy, histologic confirmation was not pursued. Intravenous methylprednisolone led to rapid defervescence and biochemical improvement. On follow-up, 18F-FDG PET/CT demonstrated complete metabolic normalization. Subsequent surveillance imaging incidentally identified an asymptomatic Stanford type A aortic dissection. In the absence of indications for elective repair (diameter below surgical thresholds, no rapid expansion, malperfusion, or significant regurgitation) and after discussion within the multidisciplinary Heart Team, management consisted of structured imaging surveillance and optimal medical therapy. Thereafter, he initiated adagrasib, achieving a durable partial response. This case illustrates discordance between metabolic quiescence and later structural damage in immune checkpoint inhibitor-associated aortitis. This supports long-term structural surveillance, as 18F-FDG PET/CT normalization does not guarantee structural safety.
PB Frontiers Media
YR 2026
FD 2026-03-13
LK https://hdl.handle.net/10347/47273
UL https://hdl.handle.net/10347/47273
LA eng
NO Freijido Alvarez, P., Mateos, L. A. L., Gonzalez Garcia, N., Garcia Gonzalez, J., Zapico, E. H., Pumar, M. G., & Lopez Lopez, R. (2026). Case Report: From metabolic normalization to incidental type A aortic dissection in immune checkpoint inhibitor-associated aortitis. Frontiers in oncology, 16, 1755873. https://doi.org/10.3389/fonc.2026.1755873
NO The author(s) declared that financial support was received for this work and/or its publication. Funded by Xunta de Galicia - GAIN, grant number IN607A2024/05 (Financiado por Xunta de Galicia – GAIN con código de expediente IN607A2024/05).
DS Minerva
RD 23 may 2026