Tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report

Abstract Background Tuberculosis (TB) reactivation has been increasingly identified following immune checkpoint inhibitor (ICI) therapy for cancer patients. However there has been no report on TB reactivation in the gastrointestinal tract. In the report, we describe a patient who developed TB ileiti...

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Autores principales:	Kin-Sang Lau, Ben Man-Fei Cheung, Ka-On Lam, Sum-Yin Chan, Ka-Ming Lam, Chun-Fai Yeung, Ivan Fan-Ngai Hung, Dora Lai-Wan Kwong, Chi-Chung Tong, To-Wai Leung, Mai-Yee Luk, Anne Wing-Mui Lee, Kwok-Keung Yuen, Victor Ho-Fun Lee
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Nasopharyngeal carcinoma Immune checkpoint inhibitors Tuberculosis reactivation IGRA Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/2540bea4e0744c0db3e2bb0711216fb7
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spelling	oai:doaj.org-article:2540bea4e0744c0db3e2bb0711216fb72021-11-14T12:44:26ZTuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report10.1186/s12879-021-06845-71471-2334https://doaj.org/article/2540bea4e0744c0db3e2bb0711216fb72021-11-01T00:00:00Zhttps://doi.org/10.1186/s12879-021-06845-7https://doaj.org/toc/1471-2334Abstract Background Tuberculosis (TB) reactivation has been increasingly identified following immune checkpoint inhibitor (ICI) therapy for cancer patients. However there has been no report on TB reactivation in the gastrointestinal tract. In the report, we describe a patient who developed TB ileitis after pembrolizumab for her metastatic nasopharyngeal carcinoma (NPC). Rechallenge with pembrolizumab after its temporary interruption together with anti-TB therapy produced continuous tumor response but without further TB reactivation. Case presentation A 29-year-old lady with metastatic NPC involving the cervical nodes, lungs and bones started pembrolizumab after failure to multiple lines of chemotherapy. She complained of sudden onset of abdominal pain, vomiting and bloody diarrhea with mucus 21 months after pembrolizumab. Colonoscopy revealed terminal ileitis with multiple caseating granulomas with Langerhan cells. Serum interferon gamma release assay was strongly positive. She was treated with anti-TB medication and was later rechallenged with pembrolizumab for her progressive lung metastases without further TB relapse while her lung metastases were brought under control again. Conclusion To date, this is the first gastrointestinal TB reactivation after ICI therapy for cancer. Guidelines to screen for TB before initiation of ICIs in endemic areas should be established.Kin-Sang LauBen Man-Fei CheungKa-On LamSum-Yin ChanKa-Ming LamChun-Fai YeungIvan Fan-Ngai HungDora Lai-Wan KwongChi-Chung TongTo-Wai LeungMai-Yee LukAnne Wing-Mui LeeKwok-Keung YuenVictor Ho-Fun LeeBMCarticleNasopharyngeal carcinomaImmune checkpoint inhibitorsTuberculosis reactivationIGRAInfectious and parasitic diseasesRC109-216ENBMC Infectious Diseases, Vol 21, Iss 1, Pp 1-5 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Nasopharyngeal carcinoma Immune checkpoint inhibitors Tuberculosis reactivation IGRA Infectious and parasitic diseases RC109-216
spellingShingle	Nasopharyngeal carcinoma Immune checkpoint inhibitors Tuberculosis reactivation IGRA Infectious and parasitic diseases RC109-216 Kin-Sang Lau Ben Man-Fei Cheung Ka-On Lam Sum-Yin Chan Ka-Ming Lam Chun-Fai Yeung Ivan Fan-Ngai Hung Dora Lai-Wan Kwong Chi-Chung Tong To-Wai Leung Mai-Yee Luk Anne Wing-Mui Lee Kwok-Keung Yuen Victor Ho-Fun Lee Tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report
description	Abstract Background Tuberculosis (TB) reactivation has been increasingly identified following immune checkpoint inhibitor (ICI) therapy for cancer patients. However there has been no report on TB reactivation in the gastrointestinal tract. In the report, we describe a patient who developed TB ileitis after pembrolizumab for her metastatic nasopharyngeal carcinoma (NPC). Rechallenge with pembrolizumab after its temporary interruption together with anti-TB therapy produced continuous tumor response but without further TB reactivation. Case presentation A 29-year-old lady with metastatic NPC involving the cervical nodes, lungs and bones started pembrolizumab after failure to multiple lines of chemotherapy. She complained of sudden onset of abdominal pain, vomiting and bloody diarrhea with mucus 21 months after pembrolizumab. Colonoscopy revealed terminal ileitis with multiple caseating granulomas with Langerhan cells. Serum interferon gamma release assay was strongly positive. She was treated with anti-TB medication and was later rechallenged with pembrolizumab for her progressive lung metastases without further TB relapse while her lung metastases were brought under control again. Conclusion To date, this is the first gastrointestinal TB reactivation after ICI therapy for cancer. Guidelines to screen for TB before initiation of ICIs in endemic areas should be established.
format	article
author	Kin-Sang Lau Ben Man-Fei Cheung Ka-On Lam Sum-Yin Chan Ka-Ming Lam Chun-Fai Yeung Ivan Fan-Ngai Hung Dora Lai-Wan Kwong Chi-Chung Tong To-Wai Leung Mai-Yee Luk Anne Wing-Mui Lee Kwok-Keung Yuen Victor Ho-Fun Lee
author_facet	Kin-Sang Lau Ben Man-Fei Cheung Ka-On Lam Sum-Yin Chan Ka-Ming Lam Chun-Fai Yeung Ivan Fan-Ngai Hung Dora Lai-Wan Kwong Chi-Chung Tong To-Wai Leung Mai-Yee Luk Anne Wing-Mui Lee Kwok-Keung Yuen Victor Ho-Fun Lee
author_sort	Kin-Sang Lau
title	Tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report
title_short	Tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report
title_full	Tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report
title_fullStr	Tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report
title_full_unstemmed	Tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report
title_sort	tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/2540bea4e0744c0db3e2bb0711216fb7
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Tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report

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