Although patients with malignancy on anti-cancer chemotherapy are known to be more susceptible to tuberculosis (TB), the clinical characteristics and treatment responses of these patients are not well known. The aim of this study was to elucidate the clinical characteristics of the TB developed in patients on anti-cancer therapy.
Patients diagnosed and treated for TB during the period of anti-cancer chemotherapy from Jan. 1 2000 to Dec. 31 2003 were enrolled at the Seoul National University Hospital, Seoul, Korea. Patients with other known risk factors for development of TB such as diabetes, HIV infection or immune suppressant treatment were excluded for the analysis. Data were collected with retrospective review of medical records.
21 cases were enrolled and their mean age was 54.9 ± 13.5 years. Male to female ratio was 3.2. Most common underlying malignancy was gastric cancer (8 patients, 38.1%). Lung cancer (3 patients, 14.3%), head & neck cancer (3 patients, 14.3%) and lymphoma (2 patients, 9.5%) were also common. Pulmonary TB developed in 18 patients (85.7%) and extrapulmonary TB in others (14.3%). Among 21 patients with pulmonary TB, 13 patients had abnormal radiographic lesion in upper lobe(s) suggesting previously healed TB before the initiation of anti-cancer chemotherapy. In all these 13 patients with previously healed TB, active pulmonary TB developed in the same lobe or ipsilateral pleura during anti-cancer treatment. All patients with TB were treatment with regimen based on 1st line anti-TB drugs. The mean duration of anti-TB treatment was 9.73± 4.3 months. Among 10 patients with pulmonary TB completed anti-TB treatment, 8 patients showed bacteriologic or radiographic improvement.
Pulmonary TB was the most common type of TB in patients with malignancy on anti-cancer chemotherapy and they usually responded well to anti-TB treatment.
The short course chemotherapy based on 1st line drugs might be used safely in patients with TB on anti-cancer chemotherapy. Patients with the radiographic evidence of previously healed TB on anti-cancer chemotherapy should be closely monitored for the recurrence of TB.
D.K. Kim, None.