Abstract：
BACKGROUND: Immune checkpoint inhibitors (ICIs) have become key agents in the treatment of nonsmall cell lung cancer worldwide. However, immune-related adverse events (irAEs) must be addressed to maximize the efficacy of ICIs. Mycobacterium tuberculosis (Mtb) infection is considered as a type of irAE associated with ICIs, but the underlying mechanism is not completely understood. Here, we present a case of pulmonary tuberculosis (TB) that developed during administration of nivolumab and ipilimumab for pulmonary adenocarcinoma that recurred just 2 months after completion of anti-TB treatment.
METHODS: A 67-year-old man with lung adenocarcinoma was referred to our hospital for chemotherapy. He was a former smoker and had been diagnosed with stage IVA (cT4N1M1a) lung adenocarcinoma. Interferon-gamma release assay (IGRA) yielded positive results at the start of treatment. One month after initiating treatment with nivolumab and ipilimumab, he presented with productive cough and Mtb complex was cultured from sputum samples. Two months after completing anti-TB treatment, recurrence of TB was observed. The series of strains were found to be identical.
CONCLUSIONS: This represents the first report of pulmonary TB that developed during nivolumab and ipilimumab treatment, and recurred 2 months after completing anti-TB treatment. Physicians should be mindful of the potential for TB recurrence following the use of ICIs, particularly in patients showing positive results from IGRA.
METHODS: A 67-year-old man with lung adenocarcinoma was referred to our hospital for chemotherapy. He was a former smoker and had been diagnosed with stage IVA (cT4N1M1a) lung adenocarcinoma. Interferon-gamma release assay (IGRA) yielded positive results at the start of treatment. One month after initiating treatment with nivolumab and ipilimumab, he presented with productive cough and Mtb complex was cultured from sputum samples. Two months after completing anti-TB treatment, recurrence of TB was observed. The series of strains were found to be identical.
CONCLUSIONS: This represents the first report of pulmonary TB that developed during nivolumab and ipilimumab treatment, and recurred 2 months after completing anti-TB treatment. Physicians should be mindful of the potential for TB recurrence following the use of ICIs, particularly in patients showing positive results from IGRA.
摘要：
背景：免疫检查点抑制剂（ICIs）已成为全球非小细胞肺癌治疗的关键药物。然而,必须解决免疫相关不良事件(irAE),以最大限度地提高ICIs的疗效.结核分枝杆菌（Mtb）感染被认为是一种与ICIs相关的irAE，但是潜在的机制还没有完全理解。这里,我们介绍了一例肺结核(TB)病例,该病例在接受nivolumab和ipilimumab治疗肺腺癌期间发生,在抗结核治疗结束后2个月复发.
方法：一名67岁的肺腺癌患者转诊到我院接受化疗。他以前是吸烟者，被诊断出患有IVA期（cT4N1M1a）肺腺癌。干扰素-γ释放测定(IGRA)在治疗开始时产生阳性结果。在开始使用nivolumab和ipilimumab治疗一个月后，他表现为生产性咳嗽，并从痰液样本中培养了Mtb复合物。完成抗结核治疗两个月后，观察到结核病复发。发现该系列菌株是相同的。
结论：这是在nivolumab和ipilimumab治疗期间出现的第一次肺结核报告，并在完成抗结核治疗2个月后复发。医生应该注意使用ICIs后结核病复发的可能性。特别是在IGRA阳性结果的患者中。
方法：一名67岁的肺腺癌患者转诊到我院接受化疗。他以前是吸烟者，被诊断出患有IVA期（cT4N1M1a）肺腺癌。干扰素-γ释放测定(IGRA)在治疗开始时产生阳性结果。在开始使用nivolumab和ipilimumab治疗一个月后，他表现为生产性咳嗽，并从痰液样本中培养了Mtb复合物。完成抗结核治疗两个月后，观察到结核病复发。发现该系列菌株是相同的。
结论：这是在nivolumab和ipilimumab治疗期间出现的第一次肺结核报告，并在完成抗结核治疗2个月后复发。医生应该注意使用ICIs后结核病复发的可能性。特别是在IGRA阳性结果的患者中。
