Late-onset Pleural and Pericardial Effusion as Immune-related Adverse Events after 94 Cycles of Nivolumab

Intern Med. 2021 Nov 15;60(22):3585-3588. doi: 10.2169/internalmedicine.7219-21. Epub 2021 Jun 5.


A 67-year-old man with primary lung adenocarcinoma was hospitalized due to massive bilateral pleural effusion and pericardial effusion after 94 cycles of nivolumab therapy. We were unable to identify the cause of these effusions using blood tests, cytology tests, or bacterial culture of pleural effusion and thoracoscopy. Finally, we administrated corticosteroids, which immediately improved the fluid accumulation. This case may support the introduction of corticosteroids for late-onset pleural and pericardial effusion during immune checkpoint inhibitor (ICI) treatment. However, the safety of rechallenge of ICIs after the improvement of fluid accumulation is controversial.

Keywords: immune-related adverse events; lung adenocarcinoma; nivolumab; pericardial effusion; pleural effusion.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Humans
  • Lung Neoplasms* / drug therapy
  • Male
  • Nivolumab / adverse effects
  • Pericardial Effusion* / chemically induced
  • Pericardial Effusion* / diagnosis
  • Pleura
  • Pleural Effusion* / chemically induced
  • Pleural Effusion* / diagnosis


  • Nivolumab