Non-tuberculous mycobacteria lung disease due to Mycobacterium chimaera in a 67-year-old man treated with immune checkpoint inhibitors for lung adenocarcinoma: infection due to dysregulated immunity?
Immune checkpoint inhibitors (ICIs) are drugs growingly employed in cancer immunotherapy which have significantly improved the prognosis of several tumours. ICIs act by restoring the “exhausted” immune system and increasing the number of T cells active against pathogens losing tolerogenic signalling...
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| Published in: | BMC infectious diseases Vol. 23; no. 1; pp. 1 - 5 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
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BioMed Central
04.09.2023
BioMed Central Ltd Springer Nature B.V BMC |
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| ISSN: | 1471-2334, 1471-2334 |
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| Abstract | Immune checkpoint inhibitors (ICIs) are drugs growingly employed in cancer immunotherapy which have significantly improved the prognosis of several tumours. ICIs act by restoring the “exhausted” immune system and increasing the number of T cells active against pathogens losing tolerogenic signalling, which has been linked to an increased risk of infectious events. We present the case of a 67-year-old man with locally advanced lung adenocarcinoma treated with the anti-PD-L1 durvalumab. Three months after immunotherapy started, an apparent radiological progression was found with elements suggesting a parenchymal superinfection associated with weight loss, asthenia, and sputum emission. A bronchoalveolar lavage resulted positive for
Mycobacterium chimaera
, and treatment with amikacin iv (for eight weeks) and daily azithromycin, ethambutol, and rifampicin was started. Thirteen months after treatment started, the patient is alive with a stable lung condition. The case highlights the risk of non-tuberculous mycobacteria lung disease (NTM-LD) in patients receiving ICIs treatment. We hypothesise that durvalumab induced an exaggerated immune response toward the mycobacteria, leading to immunopathology and overt clinical manifestations. Clinicians should be aware of this possibility in patients receiving ICIs developing new signs/symptoms related to the respiratory tract, especially in countries with a high prevalence of NTM-LD. |
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| AbstractList | Immune checkpoint inhibitors (ICIs) are drugs growingly employed in cancer immunotherapy which have significantly improved the prognosis of several tumours. ICIs act by restoring the “exhausted” immune system and increasing the number of T cells active against pathogens losing tolerogenic signalling, which has been linked to an increased risk of infectious events. We present the case of a 67-year-old man with locally advanced lung adenocarcinoma treated with the anti-PD-L1 durvalumab. Three months after immunotherapy started, an apparent radiological progression was found with elements suggesting a parenchymal superinfection associated with weight loss, asthenia, and sputum emission. A bronchoalveolar lavage resulted positive for
Mycobacterium chimaera
, and treatment with amikacin iv (for eight weeks) and daily azithromycin, ethambutol, and rifampicin was started. Thirteen months after treatment started, the patient is alive with a stable lung condition. The case highlights the risk of non-tuberculous mycobacteria lung disease (NTM-LD) in patients receiving ICIs treatment. We hypothesise that durvalumab induced an exaggerated immune response toward the mycobacteria, leading to immunopathology and overt clinical manifestations. Clinicians should be aware of this possibility in patients receiving ICIs developing new signs/symptoms related to the respiratory tract, especially in countries with a high prevalence of NTM-LD. Immune checkpoint inhibitors (ICIs) are drugs growingly employed in cancer immunotherapy which have significantly improved the prognosis of several tumours. ICIs act by restoring the "exhausted" immune system and increasing the number of T cells active against pathogens losing tolerogenic signalling, which has been linked to an increased risk of infectious events. We present the case of a 67-year-old man with locally advanced lung adenocarcinoma treated with the anti-PD-L1 durvalumab. Three months after immunotherapy started, an apparent radiological progression was found with elements suggesting a parenchymal superinfection associated with weight loss, asthenia, and sputum emission. A bronchoalveolar lavage resulted positive for Mycobacterium chimaera, and treatment with amikacin iv (for eight weeks) and daily azithromycin, ethambutol, and rifampicin was started. Thirteen months after treatment started, the patient is alive with a stable lung condition. The case highlights the risk of non-tuberculous mycobacteria lung disease (NTM-LD) in patients receiving ICIs treatment. We hypothesise that durvalumab induced an exaggerated immune response toward the mycobacteria, leading to immunopathology and overt clinical manifestations. Clinicians should be aware of this possibility in patients receiving ICIs developing new signs/symptoms related to the respiratory tract, especially in countries with a high prevalence of NTM-LD. Keywords: Immune checkpoint inhibitors, Non-tuberculous mycobacteria, Immune-related adverse events, Mycobacterium chimaera, NTM-LD Immune checkpoint inhibitors (ICIs) are drugs growingly employed in cancer immunotherapy which have significantly improved the prognosis of several tumours. ICIs act by restoring the “exhausted” immune system and increasing the number of T cells active against pathogens losing tolerogenic signalling, which has been linked to an increased risk of infectious events. We present the case of a 67-year-old man with locally advanced lung adenocarcinoma treated with the anti-PD-L1 durvalumab. Three months after immunotherapy started, an apparent radiological progression was found with elements suggesting a parenchymal superinfection associated with weight loss, asthenia, and sputum emission. A bronchoalveolar lavage resulted positive for Mycobacterium chimaera, and treatment with amikacin iv (for eight weeks) and daily azithromycin, ethambutol, and rifampicin was started. Thirteen months after treatment started, the patient is alive with a stable lung condition. The case highlights the risk of non-tuberculous mycobacteria lung disease (NTM-LD) in patients receiving ICIs treatment. We hypothesise that durvalumab induced an exaggerated immune response toward the mycobacteria, leading to immunopathology and overt clinical manifestations. Clinicians should be aware of this possibility in patients receiving ICIs developing new signs/symptoms related to the respiratory tract, especially in countries with a high prevalence of NTM-LD. Immune checkpoint inhibitors (ICIs) are drugs growingly employed in cancer immunotherapy which have significantly improved the prognosis of several tumours. ICIs act by restoring the "exhausted" immune system and increasing the number of T cells active against pathogens losing tolerogenic signalling, which has been linked to an increased risk of infectious events. We present the case of a 67-year-old man with locally advanced lung adenocarcinoma treated with the anti-PD-L1 durvalumab. Three months after immunotherapy started, an apparent radiological progression was found with elements suggesting a parenchymal superinfection associated with weight loss, asthenia, and sputum emission. A bronchoalveolar lavage resulted positive for Mycobacterium chimaera, and treatment with amikacin iv (for eight weeks) and daily azithromycin, ethambutol, and rifampicin was started. Thirteen months after treatment started, the patient is alive with a stable lung condition. The case highlights the risk of non-tuberculous mycobacteria lung disease (NTM-LD) in patients receiving ICIs treatment. We hypothesise that durvalumab induced an exaggerated immune response toward the mycobacteria, leading to immunopathology and overt clinical manifestations. Clinicians should be aware of this possibility in patients receiving ICIs developing new signs/symptoms related to the respiratory tract, especially in countries with a high prevalence of NTM-LD.Immune checkpoint inhibitors (ICIs) are drugs growingly employed in cancer immunotherapy which have significantly improved the prognosis of several tumours. ICIs act by restoring the "exhausted" immune system and increasing the number of T cells active against pathogens losing tolerogenic signalling, which has been linked to an increased risk of infectious events. We present the case of a 67-year-old man with locally advanced lung adenocarcinoma treated with the anti-PD-L1 durvalumab. Three months after immunotherapy started, an apparent radiological progression was found with elements suggesting a parenchymal superinfection associated with weight loss, asthenia, and sputum emission. A bronchoalveolar lavage resulted positive for Mycobacterium chimaera, and treatment with amikacin iv (for eight weeks) and daily azithromycin, ethambutol, and rifampicin was started. Thirteen months after treatment started, the patient is alive with a stable lung condition. The case highlights the risk of non-tuberculous mycobacteria lung disease (NTM-LD) in patients receiving ICIs treatment. We hypothesise that durvalumab induced an exaggerated immune response toward the mycobacteria, leading to immunopathology and overt clinical manifestations. Clinicians should be aware of this possibility in patients receiving ICIs developing new signs/symptoms related to the respiratory tract, especially in countries with a high prevalence of NTM-LD. Abstract Immune checkpoint inhibitors (ICIs) are drugs growingly employed in cancer immunotherapy which have significantly improved the prognosis of several tumours. ICIs act by restoring the “exhausted” immune system and increasing the number of T cells active against pathogens losing tolerogenic signalling, which has been linked to an increased risk of infectious events. We present the case of a 67-year-old man with locally advanced lung adenocarcinoma treated with the anti-PD-L1 durvalumab. Three months after immunotherapy started, an apparent radiological progression was found with elements suggesting a parenchymal superinfection associated with weight loss, asthenia, and sputum emission. A bronchoalveolar lavage resulted positive for Mycobacterium chimaera, and treatment with amikacin iv (for eight weeks) and daily azithromycin, ethambutol, and rifampicin was started. Thirteen months after treatment started, the patient is alive with a stable lung condition. The case highlights the risk of non-tuberculous mycobacteria lung disease (NTM-LD) in patients receiving ICIs treatment. We hypothesise that durvalumab induced an exaggerated immune response toward the mycobacteria, leading to immunopathology and overt clinical manifestations. Clinicians should be aware of this possibility in patients receiving ICIs developing new signs/symptoms related to the respiratory tract, especially in countries with a high prevalence of NTM-LD. |
| ArticleNumber | 573 |
| Audience | Academic |
| Author | Gramegna, Andrea Azzarà, Cecilia Blasi, Francesco Ori, Margherita Bandera, Alessandra Lombardi, Andrea Gori, Andrea |
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| Cites_doi | 10.1093/ofid/ofaa067 10.1016/j.cmi.2020.04.020 10.1128/JVI.01728-18 10.1016/j.ccm.2014.10.002 10.1164/rccm.201501-0067OC 10.1136/thoraxjnl-2021-217260 10.1126/sciimmunol.abf3861 10.1093/cid/ciaa241 10.1038/ni.2035 10.1183/23120541.00364-2022 10.1136/esmoopen-2020-000866 |
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| Keywords | Non-tuberculous mycobacteria Immune checkpoint inhibitors Immune-related adverse events NTM-LD |
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| References | SW Pan (8537_CR7) 2021; 27 8537_CR4 8537_CR1 EJ Wherry (8537_CR2) 2011; 12 DP Boyle (8537_CR8) 2015; 191 CL Daley (8537_CR11) 2020; 71 K Anand (8537_CR10) 2020; 5 8537_CR12 A Gramegna (8537_CR5) 2022; 13 T Morelli (8537_CR3) 2022; 77 K Fujita (8537_CR9) 2020; 7 8537_CR6 |
| References_xml | – volume: 7 start-page: ofaa067 issue: 3 year: 2020 ident: 8537_CR9 publication-title: Open forum Infect Dis doi: 10.1093/ofid/ofaa067 – volume: 27 start-page: 467e9 issue: 3 year: 2021 ident: 8537_CR7 publication-title: Clin Microbiol Infect doi: 10.1016/j.cmi.2020.04.020 – ident: 8537_CR1 doi: 10.1128/JVI.01728-18 – ident: 8537_CR12 doi: 10.1016/j.ccm.2014.10.002 – volume: 191 start-page: 1310 issue: 11 year: 2015 ident: 8537_CR8 publication-title: Am J Respir Crit Care Med doi: 10.1164/rccm.201501-0067OC – volume: 77 start-page: 304 issue: 3 year: 2022 ident: 8537_CR3 publication-title: Thorax doi: 10.1136/thoraxjnl-2021-217260 – ident: 8537_CR4 doi: 10.1126/sciimmunol.abf3861 – volume: 71 start-page: E1 issue: 4 year: 2020 ident: 8537_CR11 publication-title: Clin Infect Dis doi: 10.1093/cid/ciaa241 – volume: 12 start-page: 492 issue: 6 year: 2011 ident: 8537_CR2 publication-title: Nat Immunol Nature Publishing Group doi: 10.1038/ni.2035 – ident: 8537_CR6 doi: 10.1183/23120541.00364-2022 – volume: 5 start-page: e000866 issue: 4 year: 2020 ident: 8537_CR10 publication-title: ESMO Open Elsevier Masson SAS doi: 10.1136/esmoopen-2020-000866 – volume: 13 start-page: 1 issue: June year: 2022 ident: 8537_CR5 publication-title: Front Immunol |
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| Snippet | Immune checkpoint inhibitors (ICIs) are drugs growingly employed in cancer immunotherapy which have significantly improved the prognosis of several tumours.... Abstract Immune checkpoint inhibitors (ICIs) are drugs growingly employed in cancer immunotherapy which have significantly improved the prognosis of several... |
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| SubjectTerms | Adenocarcinoma Amikacin Antibiotics Asthenia Azithromycin Bronchus Cancer immunotherapy Cancer therapies Care and treatment Case Report Case reports Clinical medicine Demographic aspects Development and progression Diagnosis Drug therapy Ethambutol Health aspects Health services Immune checkpoint inhibitors Immune response Immune system Immune-related adverse events Immunity (Disease) Immunosuppressive agents Immunotherapy Infections Infectious Diseases Inhibitors Internal Medicine Lavage Lung cancer Lung diseases Lymphocytes Lymphocytes T Medical imaging Medical Microbiology Medicine Medicine & Public Health Monoclonal antibodies Mycobacterial infections Mycobacterium chimaera Non-tuberculous mycobacteria NTM-LD Parasitology Patients PD-L1 protein Pemetrexed Prognosis Receiving Respiratory tract Rifampin Risk factors Signs and symptoms Sputum Superinfection T cells Tropical Medicine Tuberculosis Weight loss |
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| Title | Non-tuberculous mycobacteria lung disease due to Mycobacterium chimaera in a 67-year-old man treated with immune checkpoint inhibitors for lung adenocarcinoma: infection due to dysregulated immunity? |
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| Volume | 23 |
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