Yan Hongju, Wen Qin, Zhang Xi
Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing 400037, China.
J Clin Tuberc Other Mycobact Dis. 2025 Apr 11;40:100525. doi: 10.1016/j.jctube.2025.100525. eCollection 2025 Aug.
AML patients are at a high risk of opportunistic infections, with tuberculosis (TB) being a common and challenging one. The immunosuppression caused by both AML and its treatment heightens this risk. Diagnosing TB in AML patients is difficult due to the overlapping symptoms of AML and TB. This case report presents a 22-year-old man diagnosed with AML who developed disseminated TB, manifesting as a refractory tuberculous splenic abscess. Despite achieving complete remission from initial induction chemotherapy, the patient experienced persistent fever. Next-generation sequencing revealed Mycobacterium tuberculosis infection, and anti-TB treatment was initiated. Despite regular anti-tuberculosis therapy, the patient continued to have recurrent fevers, with progressive splenic enlargement and an increase in splenic lesions. Eventually, splenectomy confirmed the presence of abscess-type splenic tuberculosis and resolved the symptoms. Despite the recurrence of leukemia in the bone marrow and the development of central nervous system leukemia during the patient's treatment, complete remission was achieved again after re - induction chemotherapy and intrathecal chemotherapy. Then the patient underwent successful HSCT. This case highlights the diagnostic and therapeutic challenges in managing disseminated TB in AML patients. It underscores the importance of early and accurate diagnosis using advanced molecular techniques, close monitoring, and aggressive treatment. Surgical interventions should also be considered when standard treatments fail. Additionally, it emphasizes the need for proactive TB screening and prevention strategies in high-risk populations, such as AML patients undergoing chemotherapy.
急性髓系白血病（AML）患者发生机会性感染的风险很高，结核病（TB）是其中常见且具有挑战性的一种。AML及其治疗所导致的免疫抑制加剧了这种风险。由于AML和TB的症状重叠，在AML患者中诊断TB很困难。本病例报告介绍了一名22岁被诊断为AML的男性，他发展为播散性TB，表现为难治性结核性脾脓肿。尽管初始诱导化疗实现了完全缓解，但患者仍持续发热。二代测序显示存在结核分枝杆菌感染，于是开始抗结核治疗。尽管进行了规律的抗结核治疗，患者仍反复发热，脾进行性肿大且脾部病变增多。最终，脾切除术证实存在脓肿型脾结核并缓解了症状。在患者治疗期间，尽管骨髓中白血病复发且出现了中枢神经系统白血病，但再次进行诱导化疗和鞘内化疗后又实现了完全缓解。然后患者成功接受了造血干细胞移植（HSCT）。本病例突出了在管理AML患者播散性TB方面的诊断和治疗挑战。它强调了使用先进分子技术进行早期准确诊断、密切监测和积极治疗的重要性。当标准治疗失败时也应考虑手术干预。此外，它强调了在高危人群中，如接受化疗的AML患者，积极开展TB筛查和预防策略的必要性。
