Tuberculous Lymphadenitis in a Patient Receiving PD-1 Inhibitor for Melanoma: A Case Report and Brief Literature Review

Baran Akagunduz,Ali Cagatay Bozkina,Muhammet Ozer,Banu Lebe

doi:10.3390/curroncol28010028

Baran Akagunduz, Ali Cagatay Bozkina + Show 2 more

Open Access

https://doi.org/10.3390/curroncol28010028

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Abstract

Oncolytic immunotherapy is a novel and promising approach in clinical oncology practice. Currently, immune checkpoint inhibitors (ICIs) are the first-line treatment options for disseminated melanoma. Nivolumab is a well-defined ICI that blocks programmed cell death 1 (PD-1) and mainly increases anti-tumor immunity. The opportunistic infections are not expected with ICI therapies due to their immune reactivation effects. To date, only a few cancer patients have been reported with activated TB during ICI therapy. Here, we presented a young female patient diagnosed with histologically-confirmed tuberculous lymphadenitis while on nivolumab therapy for metastatic melanoma. The current case report represents the first described tuberculous lymphadenitis case related to anti-PD-1 based monoclonal antibody therapy. The mechanism underlying the development of TB with PD-1 inhibitor use has not been illuminated yet. Triggering of excessive inflammatory responses with ICIs therapy is a potential cause. Considering the increased utilization of ICI-based immunotherapies, the TB screening should be considered in all patients before starting PD-1 inhibitor therapy.

Highlights

Melanoma is a malignancy that primarily derives from melanocytic cells
In 2016, the first active pulmonary tuberculosis case was reported in a patient in Japan who was using nivolumab for non-small cell lung cancer (NSCLC) [10]
We describe a 38-year-old Caucasian female patient who was diagnosed with histologically confirmed tuberculous lymphadenitis while on nivolumab therapy for metastatic melanoma

Summary

Introduction

Melanoma is a malignancy that primarily derives from melanocytic cells. In the United States, it is the fifth most common cancer in men and women [1]. Limited data exist on the development of TB in cancer patients who receive ICIs, interestingly, the diagnosis of TB after ICI use has been recently increasing [9]. In 2016, the first active pulmonary tuberculosis case was reported in a patient in Japan who was using nivolumab for non-small cell lung cancer (NSCLC) [10]. There has been no extrapulmonary TB reported in the literature after ICIs use In this case report, we describe a 38-year-old Caucasian female patient who was diagnosed with histologically confirmed tuberculous lymphadenitis while on nivolumab therapy for metastatic melanoma. The current case report represents a meaningful addition to the literature given that it is the first described tuberculous lymphadenitis case related to anti-PD-1 based monoclonal antibody therapy

Case Presentation

Discussion

Conclusions