A fatal disseminated cryptococcal infection in a patient treated with zanubrutinib for Waldenström's macroglobulinemia.
J Oncol Pharm Pract
; 28(8): 1917-1921, 2022 Dec.
Article
em En
| MEDLINE
| ID: mdl-35306909
ABSTRACT
INTRODUCTION:
Zanubrutinib is a second generation, irreversible small-molecule Bruton tyrosine kinase inhibitor (BTK) approved for the treatment of Waldenström's macroglobulinemia, mantle cell lymphoma, and marginal zone lymphoma. As a class, BTKs have been linked with an increased risk of respiratory infections in clinical trials. CASE REPORT We describe a 75-year-old patient who presented with generalized weakness, fevers, dyspnea, and dry cough four months after starting zanubrutinib therapy for Waldenström's macroglobulinemia. He was subsequently diagnosed with pneumonia. Septic work-up led to diagnosis of disseminated cryptococcal infection, complicated by fungal pneumonia and meningitis. MANAGEMENT ANDOUTCOME:
Zanubrutinib was held on admission, and the patient was started on combination oral and intravenous antifungal therapy. Despite clearance of fungemia, aggressive resuscitation, and appropriate antimicrobial therapy, respiratory status deteriorated requiring intubation. His condition progressed to septic shock, multiorgan failure, and demise. DISCUSSION/CONCLUSION:
We report herein a case of fatal disseminated cryptococcosis in the setting of zanubrutinib use for Waldenström's macroglobulinemia. At the time of diagnosis, his Waldenström's macroglobulinemia was in a partial response. The mechanism by which Bruton tyrosine kinase inhibitors (BTKs) lead to invasive fungal infections in these patients remains to be explored. T- and B-cell immune defects accompanying low-grade B-cell lymphomas may contribute to the severity of these infections.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Linfoma de Células B
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Macroglobulinemia de Waldenstrom
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Criptococose
Limite:
Adult
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Aged
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Humans
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Male
Idioma:
En
Revista:
J Oncol Pharm Pract
Assunto da revista:
FARMACIA
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Estados Unidos