Avelumab
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Laryngeal tuberculosis: case report A 69-year-old man developed laryngeal tuberculosis (TB) during treatment with avelumab for metastatic nasopharyngeal carcinoma. The man presented with a sore throat, progressive voice hoarseness, dysphagia and weight loss for 6 months. His medical history was notable for metastatic nonkeratinising nasopharyngeal carcinoma, for which he had started receiving palliative immunotherapy with avelumab 10 mg/kg every month [route not stated] along with valproic acid during the previous year, following initial chemoradiation in 2015. At presentation, trans-nasal endoscopy showed supraglottic oedema with the granular appearance and endolaryngeal mucopus, with intact vocal cord mobility. Thereafter, he was shifted to the operating room for direct laryngoscopy, cultures and biopsies. However, while the test results were awaited, his dysphagia and failure to thrive worsened, which necessitated hospitalisation. Chest X-ray revealed multifocal ground-grass, nodular opacities. Video-fluoroscopic swallow study demonstrated aspiration with all fluid consistencies and penetration with pureed foods; therefore, a gastrostomy tube was placed. The initial laryngoscopy results were suggestive of several differential diagnoses, including infection, malignancy, granulomatous disease and sarcoidosis. Chest X-ray findings were typical of reactivated TB, and subsequent sputum cultures confirmed the presence of positive acid-fast bacilli, leading to the diagnosis of reactivation of latent TB secondary to avelumab [with laryngeal TB as its presenting symptom; time to reaction onset not clearly stated]. Therefore, the man’s treatment with avelumab was stopped, and he started receiving quadruple antibiotic therapy comprising isoniazid, rifampicin [rifampin], pyrazinamide and ethambutol, with subsequent clinical improvement in his voice and swallowing. On follow-up after 9 months, evolving supraglottic stenosis, which is a known sequelae of tuberculosis laryngitis, was noted. On follow-up after 1 year, he remained dependent on the gastrostomy tube for nutrition. Song JS, et al. Laryngeal tuberculosis in a patient on avelumab for metastatic nasopharyngeal carcinoma. Journal of Immunotherapy 43: 222-223, No. 7, Sep 2020. Available 803516001 from: URL: http://doi.org/10.1097/CJI.0000000000000324
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Reactions 21 Nov 2020 No. 1831
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