Ibrutinib
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Invasive bronchopulmonary aspergillosis: case report A 74-year-old man developed invasive bronchopulmonary aspergillosis during treatment with ibrutinib for chronic lymphocytic lymphoma (CLL). The man was diagnosed with CLL complicated by neutropenia. A brain MRI scan exhibited abnormal findings, and he presented to a hospital. One month prior to the presentation, he started receiving ibrutinib [dosage and route not stated]. He had experienced agitation, increasing confusion and gait instability for 2 weeks. The brain MRI scan showed multiple bilateral enhancing and nonenhancing lesions, involving both cerebral hemispheres. A chest CT scan with IV contrast exhibited multiple pulmonary masses, mediastinal adenopathy and enlarged spleen with an infiltrative mass. Based on these findings, a secondary malignancy was suspected and a CT-guided biopsy of the lung mass was performed. Pathology of the initial specimen revealed fungal hyphae. Immunohistochemical staining showed focal atypical lymphoid cells positive for PAX5 and CD5. A focal infiltrative lymphoma was suspected. A second CT-guided biopsy of a different lung nodule was performed along with sputum culture. Both sputum culture, and biopsy, grew Aspergillus species [duration of treatment to reaction onset not stated]. The man’s ibrutinib therapy was held initially and voriconazole treatment was started. However, due to the concern for worsening neutropenia off treatment, ibrutinib therapy was reinitiated at a lower dose. He exhibited a rapid response both clinically and on imaging studies. Oliver T, et al. Invasive aspergillosis in the setting of ibrutinib therapy for chronic lymphocytic leukemia. American Journal of Respiratory and Critical Care Medicine 199: 803447342 (plus poster) abstr. A6880, May 2019. Available from: URL: http://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A6860 [abstract]
0114-9954/20/1787-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 18 Jan 2020 No. 1787
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