COVID-19 pneumonia and immune-related pneumonitis: critical issues on differential diagnosis, potential interactions, and management

Figures & data

Table 1. Hallmarks of COVID-19 pneumonia and immune-related pneumonitis.

	COVID-19 Pneumonia	Immune-related pneumonitis
Causative agent	Severe Acute Respiratory Syndrome Coronavirus 2	Immune checkpoints inhibitors (anti-PD-1/PD-L1 and anti-CTLA4 antibodies)
Clinical features	Cough, fever Dyspnea (in severe cases)	Cough, Dyspnea Fever is less common
Radiological findings	Ground-Glass Opacities Multiple and bilateral mottling with peripheral distribution, Reticular pattern and vascular thickening	Ground-Glass Opacities Cryptogenic organizing pneumonia-like Interstitial pneumonia pattern Hypersensitivity pneumonitis Pneumonitis not otherwise specified
Histopathology	Edema, proteinaceous exudate, vascular congestion, inflammatory clusters with multinucleated giant cells, interstitial fibrosis	Diffuse alveolar damage Sarcoid-like granulomatous reaction interstitial fibrosis
Mild-event Treatment	Isolation, surveillance Symptomatic treatment No steroids	Symptomatic treatment Oral steroids
Serious-event Treatment	Oxygen support Anti-inflammatory drugs and steroids Monoclonal antibodies, Immunoglobulins, Antimalarials drugs, Antiviral agents Mechanical ventilation, intensive care for ARDS	High-dose i.v. corticosteroids Immunosuppressive agents Oxygen support Intensive Care for ARDS