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Cervical Lymphadenopathy in Concomitant CML and Tuberculosis: A Case Report
Afia Aziz1, Awni Alshurafa2, Mohammad Yassin2
1Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Insights
New or persistent lymphadenopathy in chronic myeloid leukemia (CML) patients on tyrosine kinase inhibitors (TKIs) requires investigation for opportunistic infections like tuberculosis (TB). Prompt diagnosis and treatment of concurrent TB are crucial for optimal patient outcomes.
Area of Science:
- Hematology
- Oncology
- Infectious Diseases
Background:
- Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the Philadelphia chromosome.
- Lymphadenopathy is an uncommon presentation of CML, often attributed to the disease itself.
- Tyrosine kinase inhibitors (TKIs) used in CML treatment can impact T-cell immunity, necessitating careful evaluation of new or persistent lymphadenopathy.
Observation:
- A 35-year-old male with chronic-phase CML presented with cervical lymphadenopathy initially presumed to be CML-related.
- Lymph node biopsy revealed concurrent tuberculosis (TB) infection alongside CML.
- The patient's lymphadenopathy resolved after initiating anti-tuberculous therapy.
Findings:
- This case underscores the importance of investigating lymphadenopathy in CML patients, especially those on TKIs.
- Opportunistic infections, such as TB, should be considered in the differential diagnosis.
- Concurrent TB infection can mimic or complicate CML presentation.
Implications:
- Early and accurate diagnosis of opportunistic infections in CML patients is critical.
- Prompt management of concurrent infections like TB can prevent complications and improve CML patient outcomes.
- This case emphasizes the need for a comprehensive diagnostic approach in CML patients with lymphadenopathy.
Introduction:
Chronic myeloid leukemia is a myeloproliferative disorder characterized by the uncontrolled proliferation of mature and maturing granulocytes in the bone marrow, along with the presence of the Philadelphia chromosome. Lymphadenopathy is an uncommon initial manifestation of CML and is typically attributed to the disease itself. However, with the use of tyrosine kinase inhibitors (TKIs), which can affect T-cell-mediated immunity, new or persistent lymphadenopathy in CML patients warrants investigation to rule out opportunistic infections, including tuberculosis (TB), or progression to the blast phase of CML.
Case Presentation:
A 35-year-old male diagnosed with chronic-phase CML initially presented with cervical lymphadenopathy. The lymphadenopathy was initially attributed to CML. Further evaluation, including a lymph node biopsy, revealed concurrent TB infection. Treatment with appropriate anti-tuberculous therapy led to the resolution of the lymphadenopathy.
Conclusion:
This case highlights the importance of considering opportunistic infections, such as TB, in CML patients presenting with lymphadenopathy, particularly those on TKI therapy. Prompt investigation and appropriate management are crucial to avoid complications and ensure optimal patient outcomes.
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