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Mallik S, Datta A, Sivasankar R, Malik A. Coexistence of Carcinoma and Tuberculosis in the Cecum: A Clinical Conundrum. Cureus 2024; 16:e58675. [PMID: 38774173 PMCID: PMC11107136 DOI: 10.7759/cureus.58675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/24/2024] Open
Abstract
The coexistence of carcinoma of the colon and tuberculosis (TB) represents a rare and intricate clinical scenario. It poses significant challenges in both diagnosis and management. Clinical prediction of this coexistence is challenging since the clinical features of these two conditions are often similar. Likewise, the radiology is not decisive because of the significant overlap in the image findings of carcinoma and TB. A conclusive diagnosis relies on histopathological evidence of both malignancy and TB. Here, we report a case of a 58-year-old female who presented with chronic abdominal pain. Computed tomography showed the presence of a mass in the cecum. Histopathology of tissue retrieved through colonoscopy was indicative of features of both TB and adenocarcinoma of the cecum. Mycobacterium tuberculosis was detected in the tissue by cartridge-based nucleic acid amplification test. The patient was initiated on antitubercular treatment. She underwent surgical resection of the mass and is planned for adjuvant chemotherapy.
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Affiliation(s)
- Sonali Mallik
- Pulmonary Medicine, Institute of Medical Sciences and Sum Hospital, Bhubaneswar, IND
| | - Ananda Datta
- Pulmonary Medicine, All India Institute of Medical Sciences, Deoghar, IND
| | | | - Archana Malik
- Pulmonary Medicine, All India Institute of Medical Sciences, Deoghar, IND
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2
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Liu Z, Poiret T, Meng Q, Rao M, von Landenberg A, Schoutrop E, Valentini D, Dodoo E, Peredo-Harvey I, Maeurer M. Epstein-Barr virus- and cytomegalovirus-specific immune response in patients with brain cancer. J Transl Med 2018; 16:182. [PMID: 29970101 PMCID: PMC6029420 DOI: 10.1186/s12967-018-1557-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/23/2018] [Indexed: 02/08/2023] Open
Abstract
Background Patients with brain tumor or pancreatic cancer exhibit the poorest prognosis, while immune fitness and cellular immune exhaustion impacts their survival immensely. This work identifies differences in the immune reactivity to the common human pathogens cytomegalovirus (CMV) and Epstein–Barr virus (EBV) between patients with brain tumor in comparison to those with pancreatic cancer and healthy individuals. Methods We characterized the humoral and cellular immune responses of patients with brain tumor or pancreatic cancer to cytomegalovirus structural protein pp65 (CMV-pp65) as well as Epstein–Barr nuclear antigen-1 (EBNA-1) by whole-blood assay and ELISA. Results Anti-CMV-pp65 plasma immunoglobulin gamma (IgG) titers were significantly lower in patients with brain tumor compared to healthy donors and patients with pancreatic cancer. Among the responding patients with GBM, those with a weak anti-CMV IgG response also had a decreased median overall survival (p = 0.017, 667 vs 419 days) while patients with brain tumor showed a generally suppressed anti-CMV immune-reactivity. Patients with brain tumor exhibited a significantly lower interferon gamma (IFNγ) response to EBNA-1 and CMV-pp65 compared to patients with pancreatic cancer or healthy donors. This antigen-specific response was further amplified in patients with brain tumor upon conditioning of whole blood with IL-2/IL-15/IL-21. Exclusively in this setting, among the responding patients with GBM, those exhibiting a EBV-specific cellular immune response above the median also displayed an increased median overall survival pattern compared to weak responders (753 vs 370 days, p < 0.001). Conclusions This report provides (i) a fast and easy assay using common viral antigens and cytokine stimulation to screen for immune fitness/exhaustion of patients with brain tumor in comparison to pancreatic cancer and healthy individuals and (ii) EBV/CMV-induced IFNγ production as a potential marker of survival in patients with brain tumor. Electronic supplementary material The online version of this article (10.1186/s12967-018-1557-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhenjiang Liu
- Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden.,Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Thomas Poiret
- Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden. .,Therapeutic Immunology, Karolinska University Hospital Huddinge, F79, LabMed, Hälsovägen, 14186, Huddinge, Sweden.
| | - Qingda Meng
- Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden
| | - Martin Rao
- Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden
| | - Anna von Landenberg
- Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden
| | - Esther Schoutrop
- Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden
| | - Davide Valentini
- Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden
| | | | | | - Markus Maeurer
- Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden
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Çakar B, Çiledağ A. Evaluation of coexistence of cancer and active tuberculosis; 16 case series. Respir Med Case Rep 2017; 23:33-37. [PMID: 29204340 PMCID: PMC5709315 DOI: 10.1016/j.rmcr.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction Tuberculosis is an important risk factor for cancer. Pulmonary TB and lung cancer(LC) may mimic each other especially in the aspect of the clinical and radiological features. The aim of the study was to evaluate the features and risk factors of cases with coexistence cancer and active TB. Methodology We retrospectively reviewed the medical records of patients with coexisting TB and cancer a period from 2009 to 2014. We evaluated demographic data, the ways diagnosis of TB cases, the location of TB and cancer, TB treatment results of the cases. Results We recorded 374 TB cases in our dyspensary at this study period. In 16 (4%) of these cases, a coexistence of cancer and TB was detected. The male/female ratio was 12/4. The mean age was 62,12 ± 15,13 years. There were TST results except three cases. There were ten pulmonary TB and six extra-pulmonary TB (four peripheral lymphadenopathy TB, one abdominal TB lymphadenopathy and one salivary gland TB). Cancer types were as follows; eight lung cancer, two breast cancer, one base of tongue, one endometrium cancer, one hypopharyngeal cancer, one stomach cancer, one bladder cancer and one maxillary cancer. Diagnosis of all cases was confirmed by bacteriologic and/or histopathological examination. Squamous cell carcinoma was the most common type of cancers. This rate was 9/16. All TB cases were new. There were risk factors out of two case in the cases. Five cases were died during TB treatment. Others completed TB treatment without any complication. Conclusions In our study, the coexistence of LC and pulmonary TB was more common. The local immunity is deteriorated in cancer cases. If there is pulmonary infiltrates in lung or peripheral lymphadenopathy, we must search tuberculosis too out of metastatic lesion and other infectious diseases. We should not make delay in the diagnosis of active TB in cancer cases.
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Affiliation(s)
- Beyhan Çakar
- The Department of Tuberculosis Control at Ministery of Health, Dispansery Number 7, Ankara, Turkey
- Corresponding author. Ankara Tuberculosis Control, Dispensary No 7, 06100, Cebeci, Ankara, Turkey.
| | - Aydın Çiledağ
- Ankara University School of Medicine, Chest Disease Department, Ankara, Turkey
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Evaluation of different laboratory methods for rapid diagnosis of tuberculous pleurisy. Int J Mycobacteriol 2016; 5:437-445. [DOI: 10.1016/j.ijmyco.2016.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/21/2016] [Accepted: 07/03/2016] [Indexed: 11/17/2022] Open
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Chatterjee D, Dey P. Tuberculosis revisited: Cytological perspective. Diagn Cytopathol 2014; 42:993-1001. [DOI: 10.1002/dc.23190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 06/11/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Debajyoti Chatterjee
- Department of Pathology, Post Graduate Institute of Medical Education and Research; PGIMER; Chandigarh India
| | - Pranab Dey
- Department of Cytology; Post Graduate Institute of Medical Education and Research; Chandigarh India
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Acute myeloid leukemia presenting with pulmonary tuberculosis. Case Rep Infect Dis 2014; 2014:865909. [PMID: 24987539 PMCID: PMC4058510 DOI: 10.1155/2014/865909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/30/2014] [Accepted: 05/11/2014] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 58-year-old immunocompetent man presenting with fever, cough, anorexia, weight loss, and cervical lymphadenopathy. Blood investigations revealed severe neutropenia with monocytosis. Chest imaging showed bilateral reticular infiltrates with mediastinal widening. Bronchoalveolar lavage culture and molecular test were positive for Mycobacterium tuberculosis and treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. Although pulmonary tuberculosis could explain this clinical presentation we suspected associated blood dyscrasias in view of significant monocytosis and mild splenomegaly. Bone marrow aspiration revealed acute myeloid leukemia. Thereafter the patient received induction chemotherapy and continued antituberculous treatment. After first induction of chemotherapy patient was in remission and successfully completed 6 months antituberculosis therapy without any complications. To our knowledge there has been no such case reported from the State of Qatar to date.
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El-Sharif A, Afifi S, El-Dahshan R, Rafeh N, Eissa S. Characterization of Mycobacterium tuberculosis isolated from cancer patients with suspected tuberculosis infection in Egypt: identification, prevalence, risk factors and resistance pattern. Clin Microbiol Infect 2012; 18:E438-45. [PMID: 22834638 DOI: 10.1111/j.1469-0691.2012.03974.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Data are sparse on Mycobacterium tuberculosis infection among patients with cancer in Egypt. We sought to detect the presence of tuberculosis (TB) disease among patients with malignant conditions and suspected TB and to study the main risk factors. Also, we compared different diagnostic procedures and detected the antimicrobial susceptibility of M. tuberculosis isolates against rifampin and isoniazid. One hundred patients were included in this study, all of them had malignant conditions and were suspected by the clinicians of having TB. Identification of M. tuberculosis in different specimens was performed by smear microscopy, followed by Lowenstein-Jensen medium and Mycobacterium growth indicator tube (MGIT) cultures and artus(®) real-time PCR. In addition, an indirect MGIT anti-TB susceptibility test was carried out against rifampin and isoniazid. A total of 76% of studied cases were found to be TB positive. The frequencies of TB-positive cases in the bronchogenic, haematological and solid tumour malignancy groups were 21%, 25% and 30%, respectively. Significant differences between pulmonary and extrapulmonary TB in different malignancy groups were recorded. Real-time PCR showed the highest overall diagnostic efficiency. Multidrug-resistance of M. tuberculosis to both rifampin and isoniazid was detected in 28.6% of examined isolates. Infection in cancer patients with TB was significantly more often recorded among elderly patients and those suffering from poverty. Pulmonary TB is more common than extrapulmonary TB in patients with malignancy. Real-time PCR is the most accurate and rapid method for TB diagnosis. MGIT-rifampin resistance may be used as a reliable marker for detection of multidrug-resistant TB. Diagnosis and instituting treatment course for active or latent TB infection are crucial before starting anticancer therapy.
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Affiliation(s)
- A El-Sharif
- Department of Microbiology & Immunology, Faculty of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt
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Teo M, OConnor TM, OReilly SP, Power DG. Sorafenib-Induced Tuberculosis Reactivation. ACTA ACUST UNITED AC 2012; 35:514-6. [DOI: 10.1159/000341829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Manickam A, Sivanandham M. Mycobacterium bovis BCG and purified protein derivative-induced reduction in the CD80 expression and the antigen up-take function of dendritic cells from patients with cervical cancer. Eur J Obstet Gynecol Reprod Biol 2011; 159:413-7. [PMID: 21824715 DOI: 10.1016/j.ejogrb.2011.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 06/13/2011] [Accepted: 07/11/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Clinical diagnostic studies have reported that co-existence of malignancy and tuberculosis in regions with high incidence of tuberculosis may be possible. However, simultaneous occurrence of cervical cancer (CaCx) and tuberculosis has been reported for it rarity. Our analysis of prevalence of mycobacterial infection among the study group of patients with CaCx had revealed co-infection of mycobacterium species including Mycobacterium tuberculosis. Since M. tuberculosis potentially affects the dendritic cells-mediated protective immune response, the main aim of this study was to analyse the effect of the mycobacterial infection on the immunological functions of dendritic cells (DC) in patients with CaCx. STUDY DESIGN Initially, the prevalence of mycobacterial infection was analysed in the blood samples of patients with CaCx using ELISA and PCR techniques. Later to determine the role of mycobacterial infection on immunosuppression of DC in the progression of CaCx, dendritic cell-mediated immune suppression induced by Mycobacterium bovis BCG (M. bovis BCG) and purified protein derivative (PPD) was studied in patients with CaCx. Expression of co-stimulatory molecules CD80 and CD86, and the antigen processing function of the macrophage-derived immature dendritic cells (imDC) were analysed. RESULTS When compared to untreated imDC, the PPD and M. bovis BCG-treated imDC displayed 15% and 46.7% reduced expression of CD80, respectively. However, the M. bovis BCG and PPD did not have any significant reduction in the CD86 expression. Moreover, the dextran up-take was reduced by 24.4% and 35.8% with PPD and M. bovis BCG treatment, respectively. In addition, the M. bovis BCG-treated imDC derived from patients with CaCx showed a marginal reduction of lymphocyte proliferation and the PPD-treated imDC did not show a significant stimulation of lymphocyte proliferation. CONCLUSION These results indicate that the PPD and M. bovis BCG inhibit the maturation and antigen up-take property of macrophage-derived imDC in patients with cervical cancer, suggesting that the M. tuberculosis infection may favour the progression of cervical cancer through immunosuppressed imDC.
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Affiliation(s)
- Alagar Manickam
- Department of Biotechnology, Government College of Technology, Coimbatore 641013, India.
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Abstract
BACKGROUND Tuberculosis (TB) and malignancy represent global threats claiming millions of lives and inflicting formidable suffering worldwide. Surprisingly, the pathophysiological and practical implications of their co-existence have received little attention. METHODS Therefore, we sought to review the available literature on the field and identify data regarding the association between TB and malignancy in order to highlight the neglected aspects of this association and probably derive clinically useful information. We searched PubMed up to June 2008 for case reports, case series, non-comparative and comparative studies that were written in English and reported data on the occurrence of both TB infection and a neoplastic disorder in the same patient(s). The development of mycobacterial infections in patients with immunocompromized conditions is well known and was considered outside the scope of this review. EVIDENCE SYNTHESIS The synthesis of the available evidence enabled us to establish three different types of association between malignancy and TB: (i) the development of cancer on the background of a previous tuberculous infection; (ii) the concurrent existence of TB and malignancy in the same patient(s) or clinical specimen(s); and (iii) the diagnostic challenges arising from the multi-faceted presentations of these two disorders. CONCLUSION We conclude that clinicians need to be aware of the protean manifestations of TB and cancer and maintain a high index of suspicion for simultaneous and/or misleading presentations. In addition, further research is required to determine if a tuberculous infection, being similar to other chronic infections and inflammatory conditions, may facilitate carcinogenesis.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Greece.
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Omoti CE, Olu-Eddo AN, Nwannadi AI. Co-existence of TB and adult haematological cancers in Benin City, Nigeria. Trop Doct 2010; 39:205-7. [PMID: 19762570 DOI: 10.1258/td.2009.080348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tuberculosis is an ancient human scourge that continues to be an important public health problem worldwide. As impaired immunity is closely associated with the pathogenesis of TB, an increase in the incidence of the disease among patients with cancer is anticipated. A total of 20 cases of haematological cancers co-existing with TB in a tertiary hospital in an African setting between January 2005 and September 2008 were analysed. Clinico-pathologic profiles, types of TB infection and outcome were noted. The incidence of TB in patients with haematological malignancies was 3.4%. Lymphoma and leukaemia were the most common malignancies associated with TB. With the high incidence of such cases we recommend the exclusion of an active disease prior to the initiation of cancer therapy. Chemoprophylaxis might be indicated in TB endemic areas.
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Affiliation(s)
- Caroline Edijana Omoti
- Department of Haematology and Blood Transfusion, University of Benin Teaching Hospital, Benin City, Nigeria.
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Tuberculous cervical lymphadenitis in a patient with laryngeal carcinoma. The Journal of Laryngology & Otology 2009; 124:90-2. [PMID: 19646297 DOI: 10.1017/s0022215109990739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We report an extremely rare presentation of concomitant tuberculous cervical lymphadenitis in a patient with carcinoma of the larynx. CASE REPORT A 66-year-old man presented with a nine-month history of hoarseness. He was found to have an exophytic lesion over the posterior half of the right vocal fold. He also had a palpable right jugulodigastric node. Biopsy of the vocal fold lesion revealed invasive squamous cell carcinoma. Histological analysis of an excision biopsy specimen from the lymph node was highly suggestive of tuberculosis. On further assessment of the slides, one acid-fast bacillus was seen. The patient was treated with radiotherapy to the larynx and concomitant anti-tuberculosis chemotherapy. Five months following treatment, there was no sign of laryngeal cancer recurrence; however, the patient continued to have a productive cough and night sweats. CONCLUSION To our knowledge, this is the first report of a laryngeal carcinoma with concurrent tuberculous cervical lymphadenitis. In the face of an unhelpful fine needle aspiration cytology examination, an assumption of metastatic neck disease could have been made. Subsequent surgical and/or oncological intervention would have been highly inappropriate, with potentially catastrophic effects. This case highlights the importance of proper diagnosis, and emphasises the fact that tuberculosis should always be borne in mind in the differential diagnosis.
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KIM HR, HWANG SS, RO YK, JEON CH, HA DY, PARK SJ, LEE CH, LEE SM, YOO CG, KIM YW, HAN SK, SHIM YS, YIM JJ. Solid-organ malignancy as a risk factor for tuberculosis. Respirology 2008; 13:413-9. [DOI: 10.1111/j.1440-1843.2008.01282.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arméstar F, Coll-Cantí J, Capellades J, Batlle M. [Tuberculous myelitis with paraplegia]. Med Clin (Barc) 2006; 126:556-7. [PMID: 16756912 DOI: 10.1157/13087147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kim DK, Lee SW, Yoo CG, Kim YW, Han SK, Shim YS, Yim JJ. Clinical Characteristics and Treatment Responses of Tuberculosis in Patients With Malignancy Receiving Anticancer Chemotherapy. Chest 2005; 128:2218-22. [PMID: 16236877 DOI: 10.1378/chest.128.4.2218] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to elucidate the clinical characteristics and treatment responses of tuberculosis developing in patients receiving anticancer chemotherapy. DESIGN Retrospective case-control study. SETTING The Seoul National University Hospital, a tertiary referral hospital in South Korea. PATIENTS From January 1, 2000, to July 31, 2004, patients with tuberculosis detected during the course of anticancer chemotherapy were enrolled as cases. Age- and sex-matched tuberculosis patients without any malignant disease were selected as control subjects. MEASUREMENTS AND RESULTS Twenty-four patients and 48 control subjects were enrolled. Their mean +/- SD age was 56.3 +/- 14.3 years, and the male-to-female ratio was 3:1. The most common malignancy was gastric cancer (43%). Lymphoma (17%), lung cancer (8%), and head and neck cancer (8%) were also common. In both groups, the lung was the most common site of tuberculosis involvement (87.8% and 79.2%, retrospectively). The presence of scar tissue suggesting old tuberculosis on radiography was more common in patients with tuberculosis receiving anticancer chemotherapy (66.7% vs 43.8%, p = 0.07). No difference in radiographic severity was observed between groups. A regimen based on first-line antituberculosis drugs was started in all subjects. Frequency of completion of the expected antituberculosis chemotherapy was lower in patients with tuberculosis developing with anticancer chemotherapy (58.3% vs 79.2%, p = 0.02), but it was not different after excluding the loss due to progression of underlying malignancies. Bacteriologic/radiographic responses to treatment and toxicity of antituberculosis medication sufficient to change or stop treatment were not different in both groups. CONCLUSIONS With regard to radiographic and clinical responses to antituberculosis treatment, tuberculosis developing during anticancer chemotherapy is not clinically different from tuberculosis developing in ordinary situations. Findings in this study suggest that anticancer chemotherapy is not an obstacle in treating tuberculosis.
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Affiliation(s)
- Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, Republic of Korea
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Jutte PC, van Altena R, Pras E, Thijn CJP. Causes of misdiagnosis and mistreatment of spinal tuberculosis with radiotherapy in nonendemic areas: a pitfall in diagnosis and treatment: hazards of radiotherapy on the tuberculous lesion. Spine (Phila Pa 1976) 2005; 30:E300-4. [PMID: 15928539 DOI: 10.1097/01.brs.0000163886.20464.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Report of initially misdiagnosed and mistreated cases. OBJECTIVES To report a previously undescribed misdiagnosis and subsequent mistreatment with radiation for tuberculosis of the spine and to promote awareness for tuberculosis in nonendemic areas. SUMMARY OF BACKGROUND DATA It is not seldom that radiation therapy is provided for suspected malignant spinal lesions without histologic confirmation. Literature is not available on harmful effects of radiation therapy for tuberculosis of the spine. METHODS Clinical case analysis for initial misdiagnosis and mistreatment, analysis of subsequent clinical course. RESULTS Two patients received radiotherapy on spinal lesions of suspected malignant origin. In both patients, the lesions were of tuberculous origin and the lesions increased during radiotherapy. In Case 2, the paraplegia did not heal. CONCLUSION In cases of a spinal lesion of unknown origin, tuberculosis should always be considered. Adequate biopsy for cultures and histology is mandatory. Radiotherapy locally aggravates tuberculous spinal lesions.
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Affiliation(s)
- Paul C Jutte
- Department of Orthopaedic Surgery, Groningen University Medical Centre, Groningen, The Netherlands.
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Rajaram S, Dev G, Panikar N, Singh KC, Goel N. Postmenopausal bleeding: squamous cell carcinoma of cervix with coexisting endometrial tuberculosis. Arch Gynecol Obstet 2003; 269:221-3. [PMID: 14564457 DOI: 10.1007/s00404-003-0558-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2003] [Accepted: 08/06/2003] [Indexed: 10/26/2022]
Abstract
CASE REPORT A case of squamous cell carcinoma of cervix co-existent with endometrial tuberculosis presenting as postmenopausal bleeding is being reported for its rarity. The atrophic postmenopausal endometrium is thought to be poorly supportive of tubercle bacilli. Following a radical Wertheim's hysterectomy patient had a hectic postoperative period, which responded to antitubercular treatment. Diagnosis of tuberculosis in this case was made on histopathology postoperatively and confirmed by polymerase chain reaction (PCR) on scrapes from the granulomas obtained by microdissection. CONCLUSION Tuberculosis complicating malignant disease may occur in regions with a high prevalence of disease; with a resurgence of tuberculosis worldwide this association may not be uncommon. The diagnosis and treatment of tuberculosis in a patient with cancer assumes importance as a high mortality has been seen in patients with co-existent disease.
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Affiliation(s)
- Shalini Rajaram
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, 110095 Shahdara, Delhi, India.
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Falcó V, Colomo L, Ramón Ayuso J. [A 27-year-old male with fever and mesenteric and retroperitoneal lymph nodes]. Med Clin (Barc) 2003; 121:270-5. [PMID: 12975040 DOI: 10.1016/s0025-7753(03)75193-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Vicenç Falcó
- Servicio de Enfermedades Infecciosas. Hospital Universitari Vall d'Hebron. Barcelona. Spain
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