Liu Shiyuan Anabeth, Sullivan Timothy, Bryce Clare, Chan Amy M, Cilmi Salvatore
Internal Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
BMJ Case Rep. 2019 May 31;12(5):e227500. doi: 10.1136/bcr-2018-227500.
Glioblastoma multiforme (GBM) is an aggressive tumour that can lead to lymphopaenia. Its standard treatment involves temozolomide (TMZ) chemotherapy with radiation, often with addition of corticosteroids for symptomatic management. Although TMZ is also immunosuppressive, patients receiving TMZ rarely develop disseminated opportunistic infections. Here, we report the case of a patient with GBM receiving TMZ, radiotherapy and corticosteroids, who develops an incidental new brain lesion that is found to be disseminated within a new GBM tumour site. The patient received successful early treatment of her central nervous system aspergillosis. This case illustrates the profound immunosuppressive potential of GBM in conjunction with TMZ and corticosteroids, which can lead to high-morbidity opportunistic infections concurrently with tumour progression. Future research is needed to elucidate GBM, TMZ and corticosteroids' compound immune effects and guide management that strikes a balance between treating high-morbidity infections and continuing with immunosuppressive chemotherapy.
多形性胶质母细胞瘤（GBM）是一种侵袭性肿瘤，可导致淋巴细胞减少。其标准治疗包括替莫唑胺（TMZ）化疗联合放疗，通常还会加用皮质类固醇进行症状管理。尽管TMZ也具有免疫抑制作用，但接受TMZ治疗的患者很少发生播散性机会性感染。在此，我们报告一例接受TMZ、放疗和皮质类固醇治疗的GBM患者，该患者出现了一个偶然发现的新脑病灶，经检查发现是在一个新的GBM肿瘤部位播散。该患者的中枢神经系统曲霉菌病得到了成功的早期治疗。该病例说明了GBM与TMZ和皮质类固醇联合使用时具有强大的免疫抑制潜力，这可能导致在肿瘤进展的同时发生高发病率的机会性感染。需要进一步的研究来阐明GBM、TMZ和皮质类固醇的复合免疫效应，并指导在治疗高发病率感染和继续进行免疫抑制化疗之间取得平衡的管理方法。
