Miliary Tuberculosis during R-MPV Therapy in an Elderly Patient with Primary Central Nerve System Lymphoma: A Case Report

• Published in: Case reports in oncology Vol. 16; no. 1; pp. 1054 - 1059
• Main Authors: Take, Yushiro, Shirahata, Mitsuaki, Sakai, Jun, Kubota, Yuichi, Suzuki, Tomonari, Adachi, Jun-ichi, Maesaki, Shigefumi, Mishima, Kazuhiko, Nishikawa, Ryo
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 29.09.2023; Karger Publishers
• Subjects: Calcification; Cancer therapies; Case Report; Case reports; Chemotherapy; Drugs; HIV; Human immunodeficiency virus; Immune system; Immunocompetence; Infections; latent tuberculosis infection; Lymphoma; Magnetic resonance imaging; Medical imaging; miliary tuberculosis; Nervous system; Older people; Patients; primary central nervous system lymphoma; Scars; Transplants & implants; Tuberculosis; tuberculosis reactivation; Primary central nervous system lymphoma; Chemotherapy; Tuberculosis reactivation; Latent tuberculosis infection; Miliary tuberculosis
• ISSN: 1662-6575; 1662-6575
• DOI: 10.1159/000530711

Abstract Most elderly patients with tuberculosis (TB) have previously been infected with Mycobacterium tuberculosis, which remains dormant in the body for decades and may reactivate when their immunity declines due to underlying diseases. Elderly cancer patients are at a high risk for TB, and the treatment of TB reactivation in these patients is challenging. Among cancer patients, the incidence of TB reactivation is the highest in lymphoma patients. However, the impact of chemotherapy on TB reactivation in lymphoma patients is unknown. We report the case of an immunocompetent elderly patient with primary central nervous system lymphoma (PCNSL) having no prior history of TB, who developed miliary TB during multiagent chemotherapy consisting of rituximab, high-dose methotrexate, procarbazine, and vincristine (R-MPV therapy). Retrospectively, the chest computed tomography showed calcification of the pleura, suggesting that the patient had a latent tuberculosis infection (LTBI) and developed miliary TB from the reactivation of TB triggered by the R-MPV therapy. Our case emphasizes that when chemotherapy is administered to patients with PCNSL, interferon-gamma release assay (IGRA) should be performed if there are findings on chest examination suggestive of LTBI, such as pleural calcification, and if IGRA is positive, chemotherapy should be given concurrently with LTBI treatment.