Abstract
This report describes a case of chemoradiotherapy-induced pulmonary tuberculosis (PTB). A 77-year-old patient with tongue carcinoma received chemoradiotherapy. A complete response was obtained with a combination of 60Co and intra-arterial infusion of peplomycin and 5-fluorouracil. However, near the end of treatment, pain of the glossopharyngeal region developed and gradually worsened. An analgesic (flurbiprofen axetil) and prednisolone (30mg/day) were intravenously injected to manage the unbearable severe pain, attributed to lingual arteritis. The glossal pain then gradually improved and almost subsided after 1 week of prednisolone treatment, but a high fever suddenly developed a few days later. Chest radiography revealed a round cavity-like lesion in the right upper lobe and acid-fast bacteria were cultured from sputum. In addition, PCR of the bacterial DNA identified the bacteria as Mycobacterium tuberculosis. Then, the patient was transferred to another hospital for treatment of PTB and received chemotherapy with isoniazid, rifampicin, and streptomycin. PTB responded to chemotherapy, and the patient was discharged from the hospital after 3 months. The outcome of the tongue lesion was good, although the patient received extirpation of metastatic submandibular lymph nodes. The present case shows that caution is required against PTB in patients receiving therapy for oral cancer.
