Yang Fu-Yu, Shao Lei, Su Jie, Zhang Zhen-Meng
Department of Infectious Diseases, The Affiliated Central Hospital of Shandong First Medical University, Jinan 250013, Shandong Province, China.
World J Clin Cases. 2024 Jan 26;12(3):623-629. doi: 10.12998/wjcc.v12.i3.623.
Pulmonary tuberculosis (PTB) is prevalent in immunocompromised populations, including patients with hematologic malignancies, human immunodeficiency virus infections, and chronic diseases. Effective treatment for acute promyelocytic leukemia (APL) combined with PTB is lacking. These patients show an extremely poor prognosis. Therefore, studies should establish efficient treatment options to improve patient survival and prognosis.
A 60-year-old male with pain in the right side of his chest and a fever for 4 d visited the outpatient department of our hospital. Peripheral blood smear revealed 54% blasts. Following bone marrow examinations, variant APL with TNRC18-RARA fusion gene was diagnosed. Chest computed tomography scan showed bilateral pneumonitis with bilateral pleural effusions, partial atelectasis in the lower lobes of both lungs, and the bronchoalveolar lavage fluid gene X-Pert test was positive, indicative of PTB. Carrimycin, ethambutol (EMB), and isoniazid (INH) were administered since he could not receive chemotherapy as the WBC count decreased continuously. After one week of treatment with carrimycin, the patient recovered from fever and received chemotherapy. Chemotherapy was very effective and his white blood cells counts got back to normal. After being given five months with rifampin, EMB and INH and chemotherapy, the patient showed complete remission from pneumonia and APL.
We report a case of PTB treated successfully with carrimycin with APL that requires chemotherapy.
肺结核(PTB)在免疫功能低下人群中普遍存在,包括血液系统恶性肿瘤患者、人类免疫缺陷病毒感染者和慢性病患者。目前缺乏针对急性早幼粒细胞白血病(APL)合并PTB的有效治疗方法。这些患者的预后极差。因此,应开展研究以建立有效的治疗方案,改善患者的生存率和预后。
一名60岁男性因右侧胸痛伴发热4天前来我院门诊就诊。外周血涂片显示原始细胞占54%。经骨髓检查,诊断为伴有TNRC18-RARA融合基因的变异型APL。胸部计算机断层扫描显示双侧肺炎伴双侧胸腔积液,双肺下叶部分肺不张,支气管肺泡灌洗液体外基因Xpert检测呈阳性,提示为PTB。由于白细胞计数持续下降,患者无法接受化疗,遂给予卡那霉素、乙胺丁醇(EMB)和异烟肼(INH)治疗。使用卡那霉素治疗一周后,患者热退并接受了化疗。化疗效果显著,白细胞计数恢复正常。在给予利福平、EMB和INH治疗五个月并进行化疗后,患者的肺炎和APL完全缓解。
我们报告了一例采用卡那霉素成功治疗的PTB合并APL病例,该患者需要进行化疗。