Abstract
SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Tuberculosis has been the most common of the opportunistic infection in immunocompromised patients. In 2014, 9.6 million people suffered from tuberculosis and 1.5 million died from the disease. Among hematologic malignancies, the prevalence of tuberculosis is highest in acute myeloid leukemia (AML), ranging between 3.1-6.9%. CASE PRESENTATION: We report 2 cases of acute monoblastic leukemia patients who were simultaneously diagnosed with tuberculosis.They presented with febrile neutropenia after chemotherapy. Chest and abdominal CT revealed multiple intrathoracic lymphadenopathies and hepatosplenic microabscess in both cases. Microbiological diagnosis from intrathoracic lymph nodes obtained by EBUS-TBNA confirmed acid fast bacilli and culture for tuberculosis subsequently reported Mycobacterium tuberculosis in both cases. Although the patients suffered from neutropenia, the pathology of the intrathoracic lymph nodes revealed neutrophil as the cell response to tuberculosis. Remarkable clinical improvement, including fever, was accomplished following antituberculous medications. DISCUSSION: Previous studies reported the prevalence of concomitant TB and AML was 3.1-6.9%, highest among hematologic malignancies. The reason for higher prevalence of TB in AML patients is not clear and could be result of monocyte/macrophage dysfunction. In addition, function of T lymphocytes and NK cells in AML patients is impaired. Myeloblasts produce factors, which suppress T cell activation and proliferation causing immunity impairment. The studies in the role of neutrophils in host defense mechanism against TB investigated were limited and the results remain controversy. Influx of neutrophils associates with tissue destruction leading to secondary necrosis, which induces further inflammation. In the context of acquired immune response impairment, as in our cases, neutrophils play a role as a compensation for inadequate functioning of mononuclear phagocytes and lymphocytes due to Th1 immunity failure or loss of IFN-gamma activity in AML patients. CONCLUSIONS: We reported two cases of co-existing TB lymphadenitis and AML.TB can be the cause of febrile neutropenia in AML patients. Persistent of fever after induction chemotherapy is a clue for other additional diagnosis such as TB. Present of neutrophil in site of infection, despite of neutropenic condition, suggests inadequate function of immune response in these patients. Reference #1: Mishra P, Kumar R, Mahapatra M, et al. Tuberculosis in acute leukemia: a clinico-hematological profile. Hematology 2006;11:335-340. Reference #2: Lowe DM, Redford PS, Wilkinson RJ et al. Neutrophils in tuberculosis: friend or foe? Trends Immunol 2012;33:14-25 DISCLOSURES: No relevant relationships by Viboon Boonsarngsuk, source=Web Response No relevant relationships by Tananchai Petnak, source=Web Response
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