Abstract:
Nivolumab (PD-1 inhibitor) and other immune checkpoint inhibitors are used primarily
to promote reactivation of anti-tumor immunity. However, due to their generalized
immunorestorative properties, these agents may also trigger an unusual spectrum
of side-effects termed immune-related adverse events. In the case of the lung,
pulmonary infiltrates in patients treated with the anti-PD-1 inhibitors, nivolumab,
or pembrolizumab, especially patients with non-small cell lung cancer, can result
from immune-related pneumonitis, which, until fairly recently was believed to be of
non-infective origin. This, in turn, may result in progression and pseudo-progression of
disease. An increasing body of evidence has, however, identified pulmonary tuberculosis
as an additional type of anti-PD-1 therapy-associated, immune-related adverse event,
seemingly as a consequence of excessive reactivation of immune responsiveness to
latentMycobacteriumtuberculosis infection. The current case report describes a 56-year
old Caucasian female who presented with microbiologically-confirmed tuberculosis
infection while on nivolumab therapy for non-small cell lung cancer. Notably, the
patient, seemingly the first described from the African Continent, had not received
immunosuppressive therapy prior to the diagnosis of tuberculosis.
