Most elderly patients with tuberculosis (TB) have previously been infected with Mycobacterium tuberculosis, which remains dormant in the body for decades and may reactivate when their immunity declines due to underlying diseases. Elderly cancer patients are at a high risk for TB, and the treatment of TB reactivation in these patients is challenging. Among cancer patients, the incidence of TB reactivation is the highest in lymphoma patients. However, the impact of chemotherapy on TB reactivation in lymphoma patients is unknown. We report the case of an immunocompetent elderly patient with primary central nervous system lymphoma (PCNSL) having no prior history of TB, who developed miliary TB during multiagent chemotherapy consisting of rituximab, high-dose methotrexate, procarbazine, and vincristine (R-MPV therapy). Retrospectively, the chest computed tomography showed calcification of the pleura, suggesting that the patient had a latent tuberculosis infection (LTBI) and developed miliary TB from the reactivation of TB triggered by the R-MPV therapy. Our case emphasizes that when chemotherapy is administered to patients with PCNSL, interferon-gamma release assay (IGRA) should be performed if there are findings on chest examination suggestive of LTBI, such as pleural calcification, and if IGRA is positive, chemotherapy should be given concurrently with LTBI treatment.

中文翻译：

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一名患有原发性中枢神经系统淋巴瘤的老年患者在 R-MPV 治疗期间出现粟粒性结核：病例报告。

大多数老年结核病患者此前曾感染过结核分枝杆菌，结核分枝杆菌在体内潜伏数十年，当患者因基础疾病导致免疫力下降时，可能会重新激活。老年癌症患者患结核病的风险很高，这些患者的结核病再激活的治疗具有挑战性。在癌症患者中，淋巴瘤患者结核病再激活的发生率最高。然而，化疗对淋巴瘤患者结核病再激活的影响尚不清楚。我们报告了一名免疫功能正常的老年原发性中枢神经系统淋巴瘤 (PCNSL) 患者的病例，该患者没有既往结核病史，在包括利妥昔单抗、大剂量甲氨蝶呤、丙卡巴肼和长春新碱（R-MPV 疗法）的多药化疗期间出现粟粒性结核）。回顾性地，胸部计算机断层扫描显示胸膜钙化，表明该患者患有潜伏性结核感染（LTBI），并因 R-MPV 治疗引发的结核再激活而发展为粟粒性结核。我们的病例强调，PCNSL患者化疗时，如果胸部检查发现胸膜钙化等提示LTBI的情况，应进行干扰素γ释放试验（IGRA），如果IGRA阳性，则应给予化疗与 LTBI 治疗同时进行。