Unmasked tuberculosis or lymphoma in late AIDS presenters: a difficult differential diagnosis

Soria, Alessandro; Foresti, Sergio; Fortuna, Paolo; Dolara, Alberto; Bandera, Alessandra; Lapadula, Giuseppe; Gori, Andrea

doi:10.1183/09031936.00062309

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Other, less frequent, manifestations include glaucomatous hepatitis, genito-urinary TB, splenic abscesses and hypercalcaemia. Unusual and extremely severe presentation of unmasked TB have been reported, encompassing adult respiratory distress syndrome [48], bronchiolitis obliterans organising pneumonia [55], pyomiositis [57], multiple cerebral tuberculomas [52] and haemophagocytic syndrome [58]. These manifestations are likely to be due to an IRIS-like inflammatory reaction, as a consequence of cARTinduced restoration of specific TB immune response.…”

Section: Methodsmentioning

confidence: 99%

Unmasking tuberculosis in the era of antiretroviral treatment

Lapadula¹,

Soria²,

Bandera³

et al. 2011

Eur Respir J

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Tuberculosis (TB) can develop soon after antiretroviral treatment initiation, as the result of restoration of the anti-TB specific immune response. This form of the disease is often defined as ''unmasked TB'', and it represents a major challenge for severely immune-suppressed HIV-infected subjects initiating treatment. Emergence of previously unrecognised TB disease occurs frequently in countries where TB/HIV co-infection is common, and where antiretroviral treatment has become increasingly accessible. The challenges posed by unmasked TB, such as its high incidence, the lack of reliable diagnostic tools and the uncertainties on its optimal management, may hamper our ability to face the TB/HIV epidemic. Therefore, unmasked TB appears a major threat to global health and poses additional barriers to successful HIV/AIDS care and treatment programmes.This review focuses on the epidemiology, immunopathogenesis and clinical manifestations of unmasked TB, and provides evidence-based recommendations for management and care of the disease.

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Section: Methodsmentioning

confidence: 99%

Unmasking tuberculosis in the era of antiretroviral treatment

Lapadula¹,

Soria²,

Bandera³

et al. 2011

Eur Respir J

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“…[1][2][3] Given its clinical and morphological similarities to TB, lymphoma diagnosis is often delayed in TB-infected individuals. 2,[4][5][6][7][8][9][10][11] Approximately 10% of cancer patients may have active TB, 12 which may cause a delay in antitumour therapy. The toxicity of anti-TB treatment may lead to the administration of an insufficient dose in patients with lymphoma, increasing the risk for mortality due to a curable disease.…”

Section: Introductionmentioning

confidence: 99%

Increased Risk of Lymphoma in Men Infected With Tuberculosis

Guo

Chen

Zhou

et al. 2021

Mediterr J Hematol Infect Dis

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Purpose: To identify factors associated with lymphoma in patients with anterior Mycobacterium tuberculosis (TB). Methods: A retrospective case-control analysis was performed in a highly tuberculosis-endemic area. TB-infected patients were retrospectively identified when a history of TB exists before the diagnosis of lymphoma. Inpatients with lymphoma (n=1,057) and benign tumors (n=12,916) were consecutively enrolled at Xinjiang Medical University Cancer Hospital between January 2016 and December 2019. Results: The proportion of TB in patients with lymphoma (n=148, 14.0%) was significantly higher than that in the control (benign tumor) group (n=175, 1.4%) (p<0.0001). The frequency of TB infection in patients with Hodgkin’s lymphoma, B-cell non-Hodgkin’s lymphoma (NHL), and T/NK-cell NHL is 13.6%, 14.6%, and 11.9%, respectively. Compared to other subtypes of B-cell NHL, a relatively high proportion of tuberculosis was found in patients with chronic lymphocytic leukemia /small lymphocytic lymphoma, marginal zone B-cell lymphoma, diffuse large B-cell lymphoma, corresponding to 20.6%, 18.6% and 15.3%, respectively. For T-cell NHL, the proportion of TB infection in patients with peripheral T-cell lymphoma and anaplastic lymphoma kinase-positive T-cell NHL was 26.1% and 20%, respectively. Multivariate analysis revealed male gender as an adverse risk factor was associated with lymphoma after tubercular infection. In addition, male gender and old age (>60 years) was associated with the B-cell NHL. Conclusion: A high proportion of Mycobacterium tuberculosis infection was found in patients with lymphoma. In TB-infected patients, older age and male gender are associated with susceptibility to lymphoma, suggesting the awareness of a screening program might be useful for early detection of lymphoma.

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