Research Article
Pulmonary Mycobacterium Kansasii Disease Following Programmed Cell Death-1 Inhibitor Therapy in A Patient with Hepatocellular Carcinoma
Luo Pu1,#, Xiao Wen1,#, Xun-Qi Liu1,#, Xiao-Ting Tao2, Chen Qiong1, Shao Ling1, Zhong-Yi Fan1, Pei-Ze Zhang3,*, Xiao-Hua Tan1,*, Jiang-Hong An1,*
1Department of Oncology, Shenzhen Third People’s Hospital, Shenzhen 518112, Guangdong Province, China. 2Department of Thoracic Surgery, Shenzhen Third People’s Hospital of Shenzhen, Shenzhen, 518112, China. 3Department of Pulmonary Medicine, Shenzhen Third People’s Hospital, Shenzhen 518112, Guangdong Province, China.
#，Authors contributed equally *, Correspondence Dr. Jianghong An, Ph.D, MD., Department of Oncology, Shenzhen Third People’s Hospital, Shenzhen 518112, Guangdong Province, China. Email: [email protected]. Prof. Xiaohua Tan, Ph.D, MD., Department of Oncology, Shenzhen Third People’s Hospital, Shenzhen 518112, Guangdong Province, China. Email: [email protected]. Dr. Peize Zhang, Ph.D, MD., Department of Pulmonary Medicine and Tuberculosis, Shenzhen Third People’s Hospital, Shenzhen 518112, Guangdong Province, China. Email: [email protected]. Received: September 22, 2023; Accepted: August 10, 2024; Published online: October 24, 2024. Cite this paper: Luo Pu, Xiao Wen, Xun-Qi Liu, Xiao-Ting Tao, Chen Qiong, Shao Ling, Zhong-Yi Fan, Pei-Ze Zhang, Xiao-Hua Tan, Jiang-Hong An (2024). Pulmonary Mycobacterium Kansasii Disease Following Programmed Cell Death-1 Inhibitor in A Patient with Hepatocellular Carcinoma. Global Journal of Microbiology, 5(1):1-8. http://naturescholars.com/gjmic.050101. https://doi.org/10.46633/gjmic.050101. Copyright© 2024 by Scholars Publishing, LLC.
Abstract
Pulmonary non-tuberculous Mycobacterium (NTM) diseases following programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) inhibitor immunotherapy have been infrequently reported and inadequately characterized. Herein, we report about a 28-year-old man with hepatocellular carcinoma (HCC) who presented with fever, hemoptysis, and apical cavity of the right lung, which gradually expanded following comprehensive treatments including six cycles of toripalimab, an anti-PD-1 antibody. Further workup yielded a diagnosis of pulmonary Mycobacterium kansasii disease with a positive acid-fast bacillus (AFB) smear and M. kansasii-NTM culture from bronchoalveolar lavage fluid. The patient finally died of progressive cancer, liver failure, and worsening pulmonary M. kansasii disease. Given the reported clinical observations showing that reactivation of Mycobacterium tuberculosis (MTB)/NTM infection was associated with PD-1/PD-L1 inhibitors and a high burden of MTB/NTM infection in China, We suspect that the pulmonary cavity lesions developed from the reactivation of a latent M. kansasii infection nodule induced by toripalimab. This nodule existed in the right upper lung at the time of the diagnosis of HCC. Physicians should pay more attention to the development of pulmonary NTM diseases in patients with cancer during immunotherapy regimens with immune checkpoint inhibitors. Additional clinical observations and further exploration of the underlying mechanisms are necessary for the optimal management of pulmonary NTM diseases.
Key words: hepatocellular carcinoma (HCC); immune checkpoint inhibitors (ICIs); toripalimab; immunotherapy; non-tuberculous Mycobacterium (NTM); pulmonary Mycobacterium kansasii disease.