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Interstitial lung disease and tuberculosis: case report A 69-year-old woman developed drug-induced interstitial lung disease during treatment with dasatinib for breakpoint cluster region-Abelson-(BCRABL) positive chronic myeloid leukaemia (CML). She additionally developed active tuberculosis during treatment with dasatinib and prednisolone [routes not stated]. The woman, who was diagnosed with BCRABL-positive CML, developed a lymphoblastic blast crisis. She received remission induction therapy with dasatinib 70mg twice daily and prednisolone 85mg per day. Following four cycles of intensive consolidation therapy (dasatinib 100mg once daily, prednisolone 60mg, cyclophosphamide, daunorubicin and vincristine), bone marrow biopsy showed a complete remission, then she received a maintenance therapy with dasatinib 100mg once daily. She continued dasatinib for 14 months, when she complained of a high-grade fever, dry cough and dyspnoea on exertion. The woman was treated with unspecified antibiotics, antipyretics and antitussive agents for one month; however, her symptoms did not improve. Then, she was admitted for further evaluation. On admission, she underwent various investigations. Chest CT scan showed ground-glass opacities, non-segmental subpleural consolidation, and interlobular septal thickening, without pleural effusion. Bronchoalveolar lavage did not show any abnormal shadow except interlobular septal thickening, and revealed an elevated number lymphocyte. Pathological findings of transbronchial lung biopsy indicated organising pneumonia patten or tuberculosis. Dasatinib was considered as the most the most probable drug with a total score of 6 (probable) according to the drug interaction probability scale. However, dasatinib was essential in the maintenance of CML remission; hence, it was continued without dose reduction. She was diagnosed with dasatinib-induced ILD; hence, prednisolone 20mg (0.5 mg/kg) was started. Her fever and cough disappeared soon after the treatment. CT scan showed improved findings after two weeks of prednisolone therapy. During this period, dasatinib was administered at the same dosage. Though acid-fast bacilli stain and Mycobacterium (M.) tuberculosis PCR were both negative in the BAL fluid; the acid-fast bacillus culture was found to be positive for M. tuberculosis after three weeks. She was treated with antituberculosis therapy including rifampicin, isoniazid, ethambutol and pyrazinamide for seven months. It was also considered that she had impaired cell-mediated immunity leading to tuberculosis under BCR-ABL-positive CML, continuation of dasatinib and prednisolone treatment. Thereafter, prednisolone was gradually tapered to a dose of 10 mg/day without relapse of dasatinib-induced ILD. Tani N, et al. Drug-induced interstitial lung disease associated with dasatinib coinciding with active tuberculosis. Respirology Case Reports 8: No. 7, Oct 2020. Available 803504461 from: URL: http://doi.org/10.1002/rcr2.654

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