Nodules, nodes and non-functioning macrophages: A risk with ibrutinib therapy

Area of Science:

• Oncology
• Infectious Diseases
• Pulmonology

Background:

• Case study of a 70-year-old male patient with chronic lymphocytic leukemia (CLL).
• Patient was undergoing treatment with single-agent ibrutinib therapy.
• Ibrutinib is a targeted therapy known to potentially increase infection risk.

Observation:

• Chest imaging revealed nodular changes and mediastinal lymphadenopathy.
• Positron emission tomography (PET) scan showed avid uptake in the affected areas.
• Diagnostic procedures included bronchoscopy with endobronchial ultrasound and mediastinoscopy.

Findings:

• Invasive aspergillosis was diagnosed despite negative Aspergillus blood immunology tests.
• This opportunistic fungal infection is a recognized risk associated with ibrutinib therapy.
• The patient's condition was successfully managed with appropriate antifungal medication.

Implications:

• Highlights the importance of considering invasive aspergillosis in immunocompromised patients on ibrutinib, even with non-diagnostic serology.
• Underscores the need for thorough diagnostic workup, including imaging and biopsies, for suspected infections.
• Emphasizes the efficacy of prompt antifungal treatment in managing this serious complication.