Tuberculosis versus immune-related bronchiolitis under immune checkpoint inhibitor - a diagnostic challenge.
Clara Moreno, Nieves Martinez Chanza, Lou Gonzalez Garcia et al.
✦ AI-curated · Sources linked
Case in brief
A 53-year-old man with metastatic clear-cell renal cell carcinoma developed respiratory symptoms after receiving immune checkpoint inhibitors. Imaging revealed centrilobular nodules, and QuantiFERON testing was positive. Bronchoalveolar lavage showed lymphocyte predominance and non-caseating granulomas. Despite negative PCR for tuberculosis, empirical anti-TB therapy was initiated due to the diagnostic challenge. The patient improved after adjusting the treatment regimen.
Diagnostic / clinical pearl
Clinicians should be aware of the diagnostic overlap between immune-related bronchiolitis and tuberculosis in patients receiving immune checkpoint inhibitors, particularly in endemic regions.
Why it matters
This case highlights the importance of pre-treatment latent TB screening and the need for a multidisciplinary approach to manage potential infections while continuing cancer therapy.