Ganglionar tuberculosis infection evolving to hemophagocytic lymphohistiocytosis after anti-programmed cell death 1 treatment for high-risk melanoma: a case report

Journal of Medical Case Reports

Cesar M. Costa¹  Maria C. Seiwald¹  Luiza L. Gadotti¹  Fernando Ganem¹  David E. Uip¹  Ellen C. T. Nascimento¹  Alessandra C. R. Salgues¹  Rodrigo R. Munhoz¹  Celso Arrais-Rodrigues² 

[1] Oncology Center, Hospital Sírio Libanês (HSL), Rua Dona Adma Jafet, 91, 2nd floor, Building A, 01308-050, São Paulo, SP, Brazil;Oncology Center, Hospital Sírio Libanês (HSL), Rua Dona Adma Jafet, 91, 2nd floor, Building A, 01308-050, São Paulo, SP, Brazil;Division of Hematology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil;

关键词: Tuberculosis;    Ganglionar tuberculosis;    Hemophagocytic lymphohistiocytosis;    Melanoma;    Immune-related adverse events;    Immune checkpoint inhibitors;    Anti-PD-1;    PD-1 blockade;    Nivolumab;    Immunotherapy;   

DOI  :  10.1186/s13256-021-02900-8

来源: Springer

【 摘 要 】

BackgroundHemophagocytic lymphohistiocytosis is a rare, potentially fatal syndrome of immune hyperactivation. Here we describe a ganglionar tuberculosis evolving to hemophagocytic lymphohistiocytosis following adjuvant immunotherapy in a melanoma patient.Case presentationA 76-year-old Caucasian male with melanoma started with fever, diffuse petechiae, splenomegaly, anemia, thrombocytopenia, hypofibrinogenemia, and hyperferritinemia 2 months following completion of adjuvant treatment with nivolumab. Positron emission tomography scan showed significant hypermetabolism in cervical, supraclavicular, mediastinal, and abdominal lymph nodes. Bone marrow aspiration demonstrated no alterations, except for a hypercellular pattern. Dexamethasone and intravenous immunoglobulin were started owing to suspicion of hemophagocytic lymphohistiocytosis. Core biopsy of the infracarinal lymph node revealed a chronic granulomatous inflammation and caseous necrosis, with positivity for Mycobacterium tuberculosis by polymerase chain reaction, and treatment for ganglionar tuberculosis was started.ConclusionThis case highlights the challenges involving programmed cell death 1 blockade in high-risk melanoma, in which infections, lymphoproliferative disorders, and sarcoidosis can mimic disease progression and trigger immune-related adverse events.

【 授权许可】

CC BY