Okamoto Mariko, Kim Young Hak, Ouchi Aiko, Yamaoka Takashi, Iwamoto Natsuhiko, Iwatsubo Shigeaki, Matsumura Kanoko, Nakamura Miho, Kin Yasuo, Shiina Yoshitaka, Funada Yasuhiro
Department of Respiratory Medicine, Takatsuki General Hospital, Takatsuki, Osaka, Japan.
Department of Respiratory Surgery, Takatsuki General Hospital, Takatsuki, Osaka, Japan.
Respir Med Case Rep. 2021 Oct 21;34:101529. doi: 10.1016/j.rmcr.2021.101529. eCollection 2021.
A 69-year-old man visited our hospital due to an abnormal shadow on a chest X-ray. Chest CT showed a mass shadow in his left lower lobe accompanied by an infiltrative shadow in the right upper lobe. Thorough examination led to a diagnosis of pulmonary squamous cell lung carcinoma, stage IIIB (T3N2M0). Combination treatment with chemotherapy and programmed cell death receptor 1 (PD-1) inhibitor was started, leading to a partial response. However, his pre-existing pulmonary infiltrative shadow progressed during the maintenance treatment with PD-1 inhibitor, and sputum culture revealed infection. Thus, exacerbation of pre-existing nontuberculous mycobacterial pulmonary disease (NTM-PD) resulting from treatment with PD-1 inhibitor was suspected. Then, treatment with PD-1 inhibitor was discontinued, and he underwent pulmonary resection after antibiotic therapy against infection. Recently, special attention has been paid to the association of (TB) infection and treatment with immune checkpoint inhibitors (ICIs) in TB-endemic areas. This case also emphasizes the importance of realizing the risk of NTM infection when treating patients with ICIs, especially in NTM-endemic areas.
一名69岁男性因胸部X光片出现异常阴影前来我院就诊。胸部CT显示其左下叶有肿块阴影，同时右上叶有浸润性阴影。经过全面检查，诊断为肺鳞状细胞癌，IIIB期（T3N2M0）。开始采用化疗与程序性细胞死亡受体1（PD-1）抑制剂联合治疗，治疗后出现部分缓解。然而，在使用PD-1抑制剂维持治疗期间，其原有的肺部浸润性阴影有所进展，痰培养显示有感染。因此，怀疑是PD-1抑制剂治疗导致原有非结核分枝杆菌肺病（NTM-PD）病情加重。随后，停用PD-1抑制剂，并在针对感染进行抗生素治疗后对其进行了肺切除术。最近，在结核病流行地区，人们特别关注结核病（TB）感染与免疫检查点抑制剂（ICIs）治疗之间的关联。该病例也强调了在使用ICIs治疗患者时，尤其是在NTM流行地区，认识到NTM感染风险的重要性。
