Metastatik Akciğer Adenokarsinom Tanılı Hastada Afatinib Tedavisi Altında Gelişen Tüberküloz Enfeksiyonu Tuberculosis Infection Under Afatinib Therapy in a Patient with Metastatic Lung Adenocarcinoma

Yıl 2025, Cilt: 39 Sayı: 1, 15 - 22, 31.05.2025

Meltem Biçen Ceyda Anar , Melike Yüksel Yavuz , Muzaffer Onur Turan , Bünyamin Sertoğullarından

Öz

Akciğer kanseri ile akciğer tüberkülozunun (TB) aynı anda teşhis edilmesi nadir bir durum olmakla beraber, akciğer kanseri tanılı hastalar süreçleri boyunca immünsüpresif durumları (hastalığın seyri ve tedavi süreçlerine bağlı) ve ortak risk faktörlerinden dolayı tüberküloz açısından risk altındadırlar. Akciğer kanseri ile akciğer tüberkülozu arasında klinik ve radyolojik özelliklerin neredeyse her zaman benzer olması ise tanıyı geciktirebilmektedir. Bu nedenle akciğer kanserli olgularda TB’ dan şüphelenilen her durumda mikrobiyolojik testler cömertlikle kullanılmalıdır. Mikobakterium tüberkülozisin çevresindeki değişikliklerin algılaması ve bunlara yanıt vermesini sağlayan önemli bir düzenleyici olan tersinir protein fosforilasyonu, konakçıda hayatta kalması için gerekli dinamik adaptif yanıtların altında yatan ana sinyal mekanizmasıdır. Bu fosforilasyon serin/tirozin kinaz inhibitörleri ile sağlanmaktadır. Bu makalede tirozin kinaz inhibitörü olan afatinib tedavisi sırasında geniş spektrumlu antibiyotik tedavisine rağmen devam eden ateş ve öksürüğü sonrasında akciğer TB tanısı alan akciğer adenokarsinomlu olgu sunulmuştur.

Although it is rare for lung cancer and pulmonary tuberculosis (TB) to be diagnosed at the same time, patients diagnosed with lung cancer are at risk for TB due to their immunosuppressive status (related to the course of the disease and treatment) and common risk factors. The fact that clinical and radiological features are almost always similar between lung cancer and pulmonary tuberculosis may delay the diagnosis. Therefore, microbiological tests should be used generously whenever TB is suspected in patients with lung cancer. Reversible protein phosphorylation, an important regulator that enables Mycobacterium tuberculosis to sense and respond to changes in its environment, is the main signalling mechanism underlying the dynamic adaptive responses required for host survival. This phosphorylation is provided by serine/tyrosine kinase inhibitors. In this article, we report a case with lung adenocarcinoma diagnosed as pulmonary TB after persistent fever and cough despite broad-spectrum antibiotic treatment during afatinib treatment, a tyrosine kinase inhibitor.

Anahtar Kelimeler

Akciğer kanseri, tüberküloz, tirozin kinaz inhibitörleri

Kaynakça

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