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...

Full description

Saved in:
Bibliographic Details
Published in:BMC infectious diseases Vol. 23; no. 1; pp. 1 - 5
Main Authors: Azzarà, Cecilia, Lombardi, Andrea, Gramegna, Andrea, Ori, Margherita, Gori, Andrea, Blasi, Francesco, Bandera, Alessandra
Format: Journal Article
Language:English
Published: London BioMed Central 04.09.2023
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
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
Italy
United States > US
Non-tuberculous mycobacteria
Immune checkpoint inhibitors
Immune-related adverse events
NTM-LD
ISSN:1471-2334, 1471-2334
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
ObjectType-Report-3
ObjectType-Case Study-4
ObjectType-Case Study-2
ObjectType-Feature-4
content type line 23
ObjectType-Report-1
ObjectType-Article-3
ISSN:1471-2334
1471-2334
DOI:10.1186/s12879-023-08537-w