1. Tuberculosis reactivation at ileum following immune checkpoint inhibition with pembrolizumab for metastatic nasopharyngeal carcinoma: a case report
- Author
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Ben Man-Fei Cheung, To-Wai Leung, Dora L.W. Kwong, Sum-Yin Chan, Chun-Fai Yeung, Victor Ho-Fun Lee, Ka-Ming Lam, Kin-Sang Lau, Kwok-Keung Yuen, Ivan Hung, Mai-Yee Luk, Ka-On Lam, Anne Wing-Mui Lee, and Chi-Chung Tong
- Subjects
Adult ,medicine.medical_specialty ,Tuberculosis ,medicine.medical_treatment ,Interferon gamma release assay ,Case Report ,Pembrolizumab ,Infectious and parasitic diseases ,RC109-216 ,Antibodies, Monoclonal, Humanized ,Gastroenterology ,Immune checkpoint inhibitors ,Ileum ,Internal medicine ,medicine ,Nasopharyngeal carcinoma ,Humans ,Ileitis ,Tuberculosis reactivation ,Chemotherapy ,IGRA ,business.industry ,Cancer ,Nasopharyngeal Neoplasms ,medicine.disease ,Immune checkpoint ,Infectious Diseases ,Female ,Neoplasm Recurrence, Local ,business - 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.
- Published
- 2021