Abstract
A 78-year-old man with autoimmune hepatitis and was receiving oral prednisone, 10 mg/day. In March 2016, he underwent laparoscopic Miles' surgery for rectal cancer. Pathological findings showed a tumor that was a poorly differentiated tubular adenocarcinoma/mucinous carcinoma (T3N1M0, stage IIIa). Oral administration of titanium silicate (TS)-1 was started as adjuvant chemotherapy. Pulmonary, hepatic, and bone metastases were observed in the first year after surgery ; bevacizumab + folinic acid, fluorouracil, and irinotecan (FOLFIRI) therapy was then initiated. The patient developed a fever and an eating disorder after 9 courses. He was diagnosed with pneumonia on chest X-ray and started on antibiotic therapy ; however, his symptoms did not improve. Staining for acid-fast bacteria (sputum) showed 3+, and loop-mediated isothermal amplification (LAMP) became positive on the 11th day of hospitalization ; thus, the patient was diagnosed with pulmonary tuberculosis and referred to a treatment facility. He was started on antituberculous medicine, acid-fast bacterial staining (sputum) became negative 2 months later, and he was discharged from hospital. Antituberculous drug therapy is scheduled for a total of half a year.
With a background of latent tuberculosis infection, immunosuppression caused by various factors, such as chemotherapy, neutropenia, and oral intake of steroids, may cause recurrence of tuberculosis. To positively identify tuberculosis infection in daily practice, it is necessary to understand various complications and drugs that may increase the risk of onset and recurrence of tuberculosis, monitor tuberculosis regularly, and consider prophylactic treatment.
