Readministration of Pembrolizumab after Treatment of Tuberculosis Activated by Initial Pembrolizumab Therapy

• Published in: Internal Medicine Vol. 60; no. 11; pp. 1743 - 1746
• Main Authors: Murakami, Shuji, Usui, Ryou, Nakahara, Yoshiro, Kondo, Tetsuro, Kato, Terufumi, Saito, Haruhiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01.06.2021; Japan Science and Technology Agency
• Subjects: Antibodies; Apoptosis; Biopsy; Case Report; Cell death; Computed tomography; Immune checkpoint; immune checkpoint inhibitor; Immune response; Immune response (cell-mediated); Internal medicine; Lymphocytes T; Mycobacterium tuberculosis; non-small cell lung cancer; Non-small cell lung carcinoma; PD-1 protein; Pembrolizumab; Pneumonitis; Small cell lung carcinoma; Tuberculosis; non-small cell lung cancer; pembrolizumab; immune checkpoint inhibitor; Mycobacterium tuberculosis
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.6002-20

Increasing the T-cell immune response to Mycobacterium tuberculosis with an anti-programmed cell death 1 (anti-PD-1) antibody may ultimately have detrimental effects. We present the case of a patient with advanced non-small cell lung cancer who developed active tuberculosis (TB) after initial treatment with pembrolizumab, an anti-PD-1 antibody. Pembrolizumab was resumed after completing anti-TB treatment, and no relapse of TB was observed clinically or radiologically. Checkpoint inhibitor-related pneumonitis (CIP) is first suspected when a pulmonary shadow presents during treatment with an anti-PD-1 antibody. It is sometimes difficult to diagnose CIP using computed tomographic images alone. Careful testing, including bacterial examinations and bronchoscopic biopsy, should be performed.