lung-cancer

Prior immunotherapy may sensitize patients to severe drug reactions from antibiotics like moxifloxacin.

A 58-year-old man with lung adenocarcinoma who had received neoadjuvant tislelizumab + carboplatin + docetaxel developed severe concurrent drug-induced liver injury (DILI) and toxic epidermal necrolysis (TEN) 10 days after starting moxifloxacin for pneumonia. Moxifloxacin was the probable causative agent (RUCAM score 9, ALDEN score 5). Prior ICI exposure may lower immune tolerance threshold and amplify T cell-mediated drug reactions. Systematic review of 28 cases found fluoroquinolones are disproportionately represented in concurrent DILI+SJS/TEN.

Key Findings

Prior ICI exposure may lower immune tolerance threshold for drug reactions
Concurrent DILI and TEN developed 10 days after moxifloxacin in post-immunotherapy patient
Moxifloxacin identified as probable causative agent (RUCAM 9, ALDEN 5)
Systematic review: fluoroquinolones disproportionately represented in concurrent DILI+SJS/TEN cases
Caution is warranted when prescribing fluoroquinolones to recent immunotherapy recipients

Implications

Clinicians should use caution when prescribing fluoroquinolones to patients who recently received immunotherapy. Intensified surveillance for drug reactions is warranted. Alternative antibiotics should be considered when possible.

Caveats

Single case report + small systematic review (n=28); abstract-only. Causal immunotherapy sensitization mechanism is hypothesized, not proven. Individual case may not represent general risk.

Source: Frontiers in immunology — 2026-01-01

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