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(2005) reported that, although quinolones generally cause fewer hypersensitivity reactions than -lactams, clear associations have been observed in a subset of patients ( Mechanistic considerations A fundamental concept underpinning drug-specific T-cell responses is the pharmacological interaction (p-i) model, which posits that certain small-molecule drugs can noncovalently interact with T-cell receptors (TCRs) and human leukocyte antigen (HLA) molecules, thereby activating antigen-specific T cells ( PD-1 inhibition and lowering of the immune-tolerance threshold The PD-1 pathway is central to the maintenance of T-cell tolerance, the regulation of effector T-cell responses, and the function of regulatory T cells ( Postoperative pneumonia and systemic inflammation Surgery and severe postoperative pneumonia are classic triggers of systemic inflammation and can disrupt immune homeostasis, promoting a hyperresponsive immune state ( Potential impact of HPA-axis activation Although the last dose of ICI was administered more than one month before surgery, the patient showed persistently elevated ACTH and cortisol levels preoperatively, suggesting sustained activation of the hypothalamicpituitaryadrenal (HPA) axis