Successful desensitization therapy involving fluoroquinolone for the treatment of a solitary tuberculoma: A case report and literature review

Abstract

The patient was a 31-year-old female with no previous health problems; however, during a health checkup in 2013, a nodule (2.5 cm in diameter) was identified in the S10 area of the left lung. No clinical symptoms were apparent. Positron emission tomography/computed tomography revealed an accumulation in the same region. The patient was suspected of having lung cancer, and video-assisted thoracoscopic surgery was performed. A histopathological examination of the resected specimen revealed epithelioid granulomas accompanied by caseous necrosis in the lesion. The culture was positive for , which led to the final diagnosis of tuberculoma. Initially, the patient underwent anti- treatment [isoniazid (INH) + rifampicin (RFP) + ethambutol (EB) + pyrazinamide (PZA)]. However, two weeks later, the development of epatic dysfunction necessitated suspension of the medication. Treatment was resumed following improvement of the hepatic function. However, this relapsed two weeks later, resulting in discontinuation of the treatment. The patient was negative for each of the four drugs in the drug-induced lymphocyte stimulation test (DLST), and drug-induced hepatotoxicity (DIH) attributable to the anti-tuberculous drugs that were administered. Therefore, desensitization therapy was initiated. EB + PZA were changed to levofloxacin (LVFX) at an initial dose of 250 mg/day (dose level increased to the maintenance dose). Subsequently, desensitization therapy with RFP and INH was applied in accordance with the Japanese Society for Tuberculosis protocol. After each drug dose level reached the maintenance dose level, the therapy was completed following administration of the drugs for the recommended duration of 6 months. There were no signs of relapse 6 months following completion of the therapy. Therefore, the patient responded well to the substitute therapy with LVFX and desensitization therapy, and the present case report provided information regarding the treatment of tuberculoma.

Antimicrobial Desensitization: A Review of Published Protocols

“…In addition, cross-reactivity between FQs is likely due to similarities in core structure, as confirmed by detecting IgEs against more than one FQ. Successful desensitization to ciprofloxacin (Supplementary Materials Table S12 in the Supplementary) [134,135,136], levofloxacin [137], and moxifloxacin [138] has been reported in a variety of patients with a history of immediate-type HSRs.…”

Solitary pulmonary caseating granulomas: A 5-year retrospective single-center analysis

“…Therefore, in all cases, the maximum SUV exceeded the reported SUV cutoff value of ~2.5 ( 17 ) for differentiating malignancy among nodular lesions. However, it is extremely difficult to differentiate between PCGs and lung cancer based on SUV alone ( 10 , 16 ). In the 3 patients with NTMPNs and concurrent lung cancer, the mean SUV was 5.6±3.0, which was not sufficient for the diagnostic differentiation of malignancy.…”

“…Anti-tuberculosis drug treatment for ~6 months is currently the standard therapy for tuberculomas. However, this therapy is associated with a high frequency of drug-induced hepatotoxicity (DIH), with the subsequent requirement for hyposensitization therapy ( 10 ). Furthermore, a diagnosis of PCG by histopathological examination does not necessarily indicate the presence of a tuberculoma: It may also represent a non-tuberculous mycobacterial pulmonary nodule (NTMPN).…”