Multidisciplinary diagnosis and treatment analysis of pulmonary tuberculosis latent infection activation in a lung cancer patient after immune checkpoint inhibitor therapy

doi:10.11958/20260542

Abstract

Abstract:

Immune checkpoint inhibitors (ICIs) have been widely used in the treatment of lung cancer. While ICIs can improve overall survival period of patients, it can also lead to a range of immune-related adverse events. This article details the diagnosis and treatment course of a patient with stage ⅢA lung squamous cell carcinoma who developed active pulmonary tuberculosis shortly after initiation of PD-1 inhibitor tislelizumab combined with TP chemotherapy. From a multidisciplinary perspective, we systematically analyze the collaboration and contributions of various specialties throughout the diagnostic process, therapeutic decision-making and overall management of the case. The report aims to elucidate the critical role of the multidisciplinary treatment in identifying tuberculosis risk associated with ICIs, achieving accurate differential diagnosis, formulating sequential treatment strategies and improving patient prognosis, thereby providing a reference for clinical practice.

Key words: lung neoplasms, immune checkpoint inhibitors, tuberculosis, pulmonary, multidisciplinary treatment

CLC Number:

R734.2，R521.9

Figures/Tables 6

References 29

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序号	作者	发表年份	患者性别/年龄	肺癌类型	免疫治疗药物	感染出现时间	影像学/ 临床表现	确诊方式	抗结核治疗时间	免疫治疗是否中断	结核病情转归	肿瘤病情转归
1	Suliman等^[8]	2021	女/58岁	肺腺癌	帕博利珠单抗	6个周期后	左肺实变伴空洞	支气管灌洗液涂片、PCR	计划9个月	暂停，未重新启动	痰菌阴转	免疫治疗进展后，二线化疗获得接近完全缓解
2	Murakami等^[10]	2021	男/73岁	肺腺癌	帕博利珠单抗	约18个月后	右肺实变、结节	痰培养、PCR	6个月	中断，完成抗结核治疗后重启	痰菌转阴（PCR和培养均阴性），肺部阴影消失	重启帕博利珠单抗后获得部分缓解
3	Nakahama等^[11]	2022	男/68岁	肺腺癌	帕博利珠单抗+化疗	4个月出现，9个月确诊	右肺S3 小结节	痰培养、PCR	12个月（报道时仍在治疗中）	未中断	右上肺结节缩小，痰培养转阴	肿瘤稳定
4	Hirano等^[12]	2024	男/67岁	肺腺癌	纳武利尤+伊匹木单抗	1个月后	空洞、左肺弥漫浸润	痰培养、PCR、VNTR证实复发	9个月	中断2个月后重启	完成抗结核治疗后2个月复发；再次治疗后痰菌转阴	免疫治疗10个月后进展，患者最终因呼吸衰竭死亡
5	Takata等^[13]	2019	男/75岁	肺腺癌	纳武利尤单抗（PD-1）	免疫治疗15个周期后	新发肺部浸润影	痰涂片、PCR、痰培养	9个月	中断，抗结核治疗4个月后重启	痰培养转为阴性	重启纳武利尤后获得部分缓解
6	Nikola等^[14]	2023	女/52岁	肺腺癌	帕博利珠单抗（PD-1）	免疫治疗33个周期后	双肺粟粒样结节、树芽征	支气管镜肺泡灌洗液培养	未明确（治疗1个月后因肝毒性暂停）	中断	症状好转，CT显示病灶吸收；结核病原学转阴	患者最终因肝衰竭死亡
7	van Eeden等^[15]	2019	女/56岁	肺腺癌	纳武利尤单抗（PD-1）	数月后	双肺新发结节、淋巴管炎	痰涂片阳性（大量）	未明确	中断	抗结核治疗后临床改善，但病原学具体转归未明确报告	肿瘤进展，患者最终死亡
8	Kato等^[16]	2020	女/75岁	肺鳞癌	度伐利尤单抗（PD-L1）	巩固治疗5周期后	双肺浸润影、树芽征	痰涂片、T-SPOT、PCR	未明确（报道时仍在治疗中）	中断	痰PCR和涂片在治疗后转为阴性，病情得到控制	肿瘤控制良好
9	Chu等^[17]	2017	男/59岁	肺腺癌	纳武利尤单抗（PD-1）	3个周期后	心包积液、心包增厚	心包积液培养、活检	6个月	中断1个周期后重启	心包及胸腔积液消退，心包积液培养转阴	纳武利尤治疗6个月后进展
10	Sirgiovanni等^[18]	2021	男/44岁	小细胞肺癌	纳武利尤+伊匹木单抗	3个周期后	双肺上叶空洞、纵隔淋巴结大	支气管镜肺泡灌洗液涂片、PCR	未明确	中断	抗感染治疗后，痰菌转阴（具体时间未明确），肺部病灶显著缩小	获得长期缓解，停药24个月仍稳定
11	李亚坤等^[19]	2025	男/65岁	肺鳞癌	帕博利珠单抗+化疗	治疗irAE过程中	双肺粟粒样结节；合并肺曲霉菌病	血NGS、痰X-pert、血培养	未明确（出院时仍在治疗中）	中断	临床症状好转，胸部CT示结节吸收，病原学未明确	免疫联合化疗后获得部分缓解

序号	作者	发表年份	患者性别/年龄	肺癌类型	免疫治疗药物	感染出现时间	影像学/ 临床表现	确诊方式	抗结核治疗时间	免疫治疗是否中断	结核病情转归	肿瘤病情转归
1	Suliman等^[8]	2021	女/58岁	肺腺癌	帕博利珠单抗	6个周期后	左肺实变伴空洞	支气管灌洗液涂片、PCR	计划9个月	暂停，未重新启动	痰菌阴转	免疫治疗进展后，二线化疗获得接近完全缓解
2	Murakami等^[10]	2021	男/73岁	肺腺癌	帕博利珠单抗	约18个月后	右肺实变、结节	痰培养、PCR	6个月	中断，完成抗结核治疗后重启	痰菌转阴（PCR和培养均阴性），肺部阴影消失	重启帕博利珠单抗后获得部分缓解
3	Nakahama等^[11]	2022	男/68岁	肺腺癌	帕博利珠单抗+化疗	4个月出现，9个月确诊	右肺S3 小结节	痰培养、PCR	12个月（报道时仍在治疗中）	未中断	右上肺结节缩小，痰培养转阴	肿瘤稳定
4	Hirano等^[12]	2024	男/67岁	肺腺癌	纳武利尤+伊匹木单抗	1个月后	空洞、左肺弥漫浸润	痰培养、PCR、VNTR证实复发	9个月	中断2个月后重启	完成抗结核治疗后2个月复发；再次治疗后痰菌转阴	免疫治疗10个月后进展，患者最终因呼吸衰竭死亡
5	Takata等^[13]	2019	男/75岁	肺腺癌	纳武利尤单抗（PD-1）	免疫治疗15个周期后	新发肺部浸润影	痰涂片、PCR、痰培养	9个月	中断，抗结核治疗4个月后重启	痰培养转为阴性	重启纳武利尤后获得部分缓解
6	Nikola等^[14]	2023	女/52岁	肺腺癌	帕博利珠单抗（PD-1）	免疫治疗33个周期后	双肺粟粒样结节、树芽征	支气管镜肺泡灌洗液培养	未明确（治疗1个月后因肝毒性暂停）	中断	症状好转，CT显示病灶吸收；结核病原学转阴	患者最终因肝衰竭死亡
7	van Eeden等^[15]	2019	女/56岁	肺腺癌	纳武利尤单抗（PD-1）	数月后	双肺新发结节、淋巴管炎	痰涂片阳性（大量）	未明确	中断	抗结核治疗后临床改善，但病原学具体转归未明确报告	肿瘤进展，患者最终死亡
8	Kato等^[16]	2020	女/75岁	肺鳞癌	度伐利尤单抗（PD-L1）	巩固治疗5周期后	双肺浸润影、树芽征	痰涂片、T-SPOT、PCR	未明确（报道时仍在治疗中）	中断	痰PCR和涂片在治疗后转为阴性，病情得到控制	肿瘤控制良好
9	Chu等^[17]	2017	男/59岁	肺腺癌	纳武利尤单抗（PD-1）	3个周期后	心包积液、心包增厚	心包积液培养、活检	6个月	中断1个周期后重启	心包及胸腔积液消退，心包积液培养转阴	纳武利尤治疗6个月后进展
10	Sirgiovanni等^[18]	2021	男/44岁	小细胞肺癌	纳武利尤+伊匹木单抗	3个周期后	双肺上叶空洞、纵隔淋巴结大	支气管镜肺泡灌洗液涂片、PCR	未明确	中断	抗感染治疗后，痰菌转阴（具体时间未明确），肺部病灶显著缩小	获得长期缓解，停药24个月仍稳定
11	李亚坤等^[19]	2025	男/65岁	肺鳞癌	帕博利珠单抗+化疗	治疗irAE过程中	双肺粟粒样结节；合并肺曲霉菌病	血NGS、痰X-pert、血培养	未明确（出院时仍在治疗中）	中断	临床症状好转，胸部CT示结节吸收，病原学未明确	免疫联合化疗后获得部分缓解