Diaco Natascha D, Strohdach Bettina, Falkowski Anna L, Hainc Nicolin, Brunner Philippe, Rutishauser Jonas, Jost Lorenz, Tarr Philip E
University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland.
Infectious Diseases Service, University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland.
J Clin Med. 2019 Feb 7;8(2):216. doi: 10.3390/jcm8020216.
Infections may constitute a serious complication in patients with chronic lymphocytic leukemia (CLL). New treatment agents including obinutuzumab and ibrutinib have improved the progression-free survival in CLL, and data suggest a similar overall infection risk and a limited risk of opportunistic infections when compared to standard chemo-immunotherapy. Nevertheless, cases of opportunistic infections including non-tuberculous mycobacterial (NTM) in CLL patients have recently been published. We present a case of a 74-year old man with extensive prior CLL treatment history, including most recently obinutuzumab. He developed an abscess of the psoas muscle and inguinal lymphadenopathy. An inguinal node biopsy specimen showed infection with , confirmed by broad-spectrum mycobacterial PCR, -specific PCR, and mycobacterial culture. This case and our literature review suggest that physicians should be aware of opportunistic infections in patients with CLL. Diagnostic differentiation from CLL disease progression, Richter's transformation to aggressive lymphoma, and secondary malignancy relies on histological and appropriate microbiological studies from biopsy material of affected organs. Infection prophylaxis in CLL should be considered, including vaccinations and intravenous immune globulin replacement.
感染可能是慢性淋巴细胞白血病（CLL）患者的严重并发症。包括奥滨尤妥珠单抗和伊布替尼在内的新型治疗药物改善了CLL患者的无进展生存期，数据表明，与标准化学免疫疗法相比，总体感染风险相似，机会性感染风险有限。然而，最近已发表了CLL患者发生机会性感染的病例，包括非结核分枝杆菌（NTM）感染。我们报告一例74岁男性患者，其有广泛的CLL既往治疗史，最近接受了奥滨尤妥珠单抗治疗。他出现了腰大肌脓肿和腹股沟淋巴结病。腹股沟淋巴结活检标本显示感染，经广谱分枝杆菌PCR、特异性PCR和分枝杆菌培养证实。该病例及我们的文献综述表明，医生应意识到CLL患者存在机会性感染。与CLL疾病进展、Richter转化为侵袭性淋巴瘤以及继发性恶性肿瘤进行诊断鉴别，依赖于对受累器官活检材料进行组织学和适当的微生物学研究。应考虑对CLL患者进行感染预防，包括接种疫苗和静脉注射免疫球蛋白替代治疗。
