Table 2.
Findings and outcomes for patients with tuberculosis.
| Patient | Time after CAR T-cell therapy to TB presentation | Initial symptoms | Imaging findings | TB location | Diagnosis | TB Treatment (n, months) | Outcome (Cause) |
|---|---|---|---|---|---|---|---|
| 1 | 23 days | fever and cough | CT Chest - patchy infiltrates and irregular flaky high-density shadow on left lung. | lungs | Xpert MTB/Rif (sputum) | 2HRZE/4HR | Alive |
| 2 | 66 days | headache, fever, vomiting and cough | CT Chest - diffuse miliary nodules throughout both lungs; Cranial MRI - focal FLAIR-weighted signal hyperintensity in left posterior limbs of the internal capsules, left corona radiata and right parietal lobe. | lungs and CNS | Xpert MTB/Rif (CSF) | 2HRZE | Relapse of ALL after 4 months of CAR T-cell therapy and lost to follow-up |
| 3 | 8 months | difficulty breathing, cough, night sweats and weight loss | CT Chest - massive pleural effusion and multiple small lung nodules. | lungs and CNS | Xpert MTB/Rif (PE); TB PCR (CSF) | 2HRZE† | Death (coma and respiratory circulatory failure due to CNS TB) |
| 4 | 10 months | cough | PET/CT - nodules and patches at the right lower lobe with a SUVmax of 10.6 and enlargement of multiple mediastinal and hilar lymph nodes with a SUVmax of 17.5. | Lungs and mediastinal lymph nodes | TB PCR (mediastinal lymph node biopsy) | 3HRZE/9HER | Alive |
| 5 | 11 months | painless subcutaneous malar nodules | PET/CT - a hypermetabolic subcutaneous malar foci with a SUVmax of 17.9 and multiple intense FDG uptake of skull and T3 vertebra with SUVmax ranging from 12.6 to 15.9. | subcutaneous tissue and bone | TB PCR (subcutaneous nodules biopsy) | 3HRZE/9HER | Alive |
†Patient 3 discontinued anti-TB treatment after 2 months of his own accord. After 5 months of withdrawal, he was diagnosed with central nervous system tuberculosis with isoniazid resistance and received RZ, levofloxacin, and linezolid as anti-TB treatment.
CAR: chimeric antigen receptor; TB: tuberculosis; CT: computerized tomography; MRI: magnetic resonance imaging; PET: positron emission tomography; fluorodeoxyglucose; SUV: standardized uptake value; FDG: fluorodeoxyglucose; CNS: central nervous system; CSF: cerebrospinal fluid; PE: pleural effusion; H: isoniazid; R: rifampin; Z: pyrazinamide; E: ethambutol