Odagiri Yukiya, Hiyama Yoshiki, Ishida Umi, Nishiyama Naotaka, Yamamoto Yoshihiro, Kitamura Hiroshi
Department of Urology Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama Toyama Japan.
Department of Clinical Infectious Diseases Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama Toyama Japan.
IJU Case Rep. 2025 Jun 24;8(5):454-457. doi: 10.1002/iju5.70063. eCollection 2025 Sep.
The association between the risk of latent tuberculosis infection (LTBI) reactivation and immune checkpoint inhibitor (ICI) administration has been reported.
A man in his seventies underwent robot-assisted laparoscopic radical cystectomy with ileal conduit diversion for muscle-invasive bladder cancer. Three years postoperatively, CT revealed metastases to the para-aortic lymph nodes and rectum. Four cycles of gemcitabine and carboplatin were administered, with CT showing a partial response (PR). Avelumab maintenance therapy was initiated following radiotherapy for the rectal metastasis. Prior to avelumab administration, LTBI was diagnosed based on a positive interferon-gamma release assay (IGRA). Isoniazid was administered concurrently with avelumab for 6 months. No active tuberculosis developed, and PR was maintained.
IGRA screening is advisable prior to ICI initiation. Prompt and appropriate management is warranted in patients with LTBI.
潜伏性结核感染（LTBI）再激活风险与免疫检查点抑制剂（ICI）给药之间的关联已有报道。
一名七十多岁男性因肌层浸润性膀胱癌接受了机器人辅助腹腔镜根治性膀胱切除术及回肠导管改道术。术后三年，CT显示腹主动脉旁淋巴结和直肠转移。给予四个周期的吉西他滨和卡铂治疗，CT显示部分缓解（PR）。直肠转移灶放疗后开始阿维鲁单抗维持治疗。在给予阿维鲁单抗之前，基于干扰素-γ释放试验（IGRA）阳性诊断为LTBI。异烟肼与阿维鲁单抗同时给药6个月。未发生活动性结核，且维持了部分缓解。
在开始ICI治疗前，建议进行IGRA筛查。对LTBI患者需要及时且适当的管理。
