Table 1.
Summary analysis of clinical and literature cases.
| Study objects | Age/gender/nationality | Cancer types | Combination therapy | ICIs | Time lag (months) | Radiologic features of TB | Clinical manifestations of TB | Diagnosis of TB | Tuberculous lesion | Treatment of TB | discontinue ICI therapy | restart ICIs | TB infection classification | Outcomes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lee (9) | 87/M/Chinese | Hodgkin lymphoma | Chemo + RT | Pembrolizumab, 5 cycles | 4 | No abnormal findings on chest CT | Fever, weight loss | Sputum culture (+) | Pulmonary TB | Isoniazid, Rifampicin, Ethambutol | Yes | No | Reactivation of LTBI | Lymphoma remission; TB stable |
| Fujita 2016 (10) | 72/M/Japanese | Lung squamous cell carcinoma | Chemotherapy | Nivolumab, 8 cycles | 4 | New centrilobular nodules with tree-in-bud sign in bilateral lungs | No specific TB-related symptoms | BAL culture (+), PCR (+), IGRA conversion from negative to positive | Pulmonary TB | Specific medication is not specified | Yes | No | New primary infection | NR |
| Chu 2017 (11) | 59/M/Chinese, Taiwan | Lung adenocarcinoma | Gefitinib + chemotherapy | Nivolumab, 3 cycles | 3 | Rapid pericardial effusion, pericardial thickening | Cardiac tamponade | Pericardial fluid culture (+), pericardial histology | Tuberculous pericarditis | Specific medication is not specified | Yes | Yes | Reactivation of LTBI | Effusions resolved; no recurrence after ICI |
| Takata 2019 (12) | 75/M/Japanese | Lung adenocarcinoma | Chemo + RT | Nivolumab, 15 cycles | 10 | New pulmonary opacities in right middle and lower lobes | Fever, cough, purulent sputum | Sputum AFB (+), PCR (+), sputum culture (+) | Pulmonary TB | HREZ | Yes | Yes | Unclassifiable | TB cured; tumor PR; paradoxical reaction relieved |
| Anastasopoulou 2019 (13) | 76/F/ Greek |
Cutaneous melanoma | IFN + steroids + infliximab | Nivolumab ± ipilimumab, 8 cycles | 6 | New GGOs and centrilobular nodules in bilateral lungs (predominantly right) | Fever, fatigue, weight loss, lower respiratory tract infection | BAL culture (+), PCR (+) | Pulmonary TB | HREZ | Yes | No | New primary infection | Respiratory deterioration; death |
| Anastasopoulou 2019 (13) | 85/M/ Greek |
Parotid melanoma | IFN + cobimetinib | Atezolizumab | 5 | No new abnormalities on initial chest X-ray | Lower respiratory tract infection, fever | Sputum culture (+) | Pulmonary TB | HREZ | Yes | Yes | Unclassifiable | On ATT, well-tolerated; antitumor therapy suspended |
| Barber 2019 (14) | 59/M/ American |
Nasopharyngeal carcinoma | None | Nivolumab, 3 cycles | 1 | Diffuse GGOs and centrilobular nodules in bilateral lungs | No specific TB-related symptoms | Lung AFB (+), PCR (+), histology; BAL & stool culture (+) | Disseminated TB (lung, rectum, intestine/peritoneum) | HREZ initially; streptomycin, moxifloxacin, linezolid for intestinal perforation | Yes | No | Reactivation of LTBI | Death |
| Barber 2019 (14) | 83/M/ American |
Metastatic Merkel cell carcinoma | None | Pembrolizumab, 11 cycles | 6 | New 1.1×1.6 cm nodule in right lower lobe | No specific TB-related symptoms | Lung AFB (+), histology; | Pulmonary TB | HREZ, Levofloxacin, Rifapentine were administered after Isoniazid administration | Yes | Yes | Reactivation of LTBI | TB cured; tumor responded to ICI |
| Sirgiovanni 2021 (15) | 44/M/ German |
SCLC | Chemo + RT | Nivolumab + ipilimumab, 3 cycles | 2 | New lesions in bilateral upper lobes, cavitation in left upper lobe | No specific TB-related symptoms | BAL AFB (+), PCR (+); sputum & gastric juice AFB (+) | Pulmonary TB | HREZ | Yes | No | New primary infection | Lesions reduced; tumor stable; 24-month disease control |
| Kato 2020 (16) | 75/F/ Japanese |
NSCLC | Chemo + RT | Durvalumab, 5 cycles | 2 | Diffuse bilateral infiltrates, cavitary primary lesion enlargement, right middle/lower lobe tree-in-bud sign | Intermittent fever (38–39°C), night sweats | Sputum AFB (+), PCR (+); T-SPOT.TB (+) | Pulmonary TB | Specific medication is not specified | Yes | No | Reinfection | TB controlled; tumor stable |
| Lau 2021 (17) | 29/F/ Chinese, Hong Kong |
Nasopharyngeal carcinoma | Chemo + RT + steroids | pembrolizumab | 20 | PET-CT: terminal ileitis, enlarged mesenteric lymph nodes | Abdominal pain, vomiting, mucoid bloody stools, persistent high fever | Ileal PCR (+), histology; QFT-IGRA (+); AFB (−) | Terminal ileum, mesenteric lymph nodes | HREZ, | Yes | Yes | Reactivation of LTBI | TB cured; tumor shrank after ICI |
| Suliman 2021 (7) | 58/F/ Qatari |
Lung adenocarcinoma | None | Pembrolizumab, 6 cycles | 12 | Left lung consolidation and cavitation; subsequent diffuse reticulonodular infiltrates bilaterally | Cough, sputum, high fever, tachycardia, hypoxemia | BAL AFB (+), PCR (+); sputum AFB (+) | Pulmonary TB | HREZ | Yes | No | Reactivation of LTBI | Sputum negative; tumor near-CR |
| Murakami 2021 (18) | 73/M/ Japanese |
Lung adenocarcinoma | Steroids | Pembrolizumab, 5 cycles | 18 | Right lower lobe faint opacity → GGO + nodule; right upper lobe consolidation + nodule | Initially asymptomatic, later cough/sputum without fever | Sputum culture (+), PCR (+); sputum AFB (−) | Pulmonary TB | HREZ | Yes | Yes | Unclassifiable | TB lesions resolved; tumor PR; no TB relapse |
| Riudavets 2022 (19) | 42/M/ French |
Pulmonary sarcoma | Chemo + RT | Pembrolizumab, ~30 cycles | 32 | Peritoneal infiltration, enlarged mesenteric/retroperitoneal lymph nodes with necrosis | Night sweats, fever, no typical respiratory symptoms | Retroperitoneal lymph node histology; clinically suspected TB | disseminated TB: Peritoneum, mesentery, retroperitoneal lymph nodes, multiple bones | HREZ | Yes | No | Unclassifiable | Symptoms relieved; tumor CR; TB controlled |
| He 2018 (20) | 65/M/ Chinese |
Malignant melanoma | High-dose IL-2 | Pembrolizumab, 10 cycles | 8 | Right upper lobe posterior segment opacity | Hemoptysis for 1 week | BAL GeneXpert (+), culture (+); lung histology | Pulmonary TB | HREZ | Yes | Yes | Reactivation of LTBI | Tumor CR; TB cured without reactivation |
| Jensen 2018 (21) | 56/M/ Caucasian |
Lung adenocarcinoma | Chemo + RT | Nivolumab, 12 cycles | 3 | Progression of right upper lobe anterior segment infiltration with cavitation; new infiltration at right apex | Progression of right upper lobe anterior segment infiltration with cavitation; new infiltration at right apex | Lung histology, AFB (+); surgical specimen PCR (+) | Pulmonary TB | Specific medication is not specified | Yes | No | Reactivation of LTBI | ATT initiated; no malignancy; tumor stable |
| Picchi 2017 (22) | 50/M/ French |
Malignant melanoma | NR | Pembrolizumab, 4 cycles | 3 | NR | Asymptomatic pleurisy | Pleural histology | Pleura | The “four-drug” regimen | No | No | Unclassifiable | Pleural effusion resolved |
| Picchi 2017 (22) | 64/M/ French |
Metastatic NSCLC | NR | Nivolumab, 2 cycles | 1 | NR | Spinal cord compression | Bone culture (+), PCR (+), histology | Bone | The “four-drug” regimen | Yes | No | Unclassifiable | Rapid death after spinal surgery |
| Nikola 2023 (23) | 52/F/ Serbian |
Lung adenocarcinoma | Chemotherapy | Pembrolizumab, 33 cycles | 25 | Multiple nodules, micronodules, tree-in-bud sign, GGOs in bilateral upper lobes | Fever, dry cough, weight loss | BAL AFB (+), culture (+), PCR (+) | Pulmonary TB | HREZ | Yes | No | New primary infection | Temporary improvement; death from liver failure |
| Tsai 2019 (24) | 49/M/ Chinese, Taiwan |
Hard palate squamous cell carcinoma | Chemo + RT | Nivolumab | 3 | Patchy high density, consolidation, and cavitary mass-like lesion in left upper lung | Fever, purulent sputum for 2 weeks, bilateral crackles | Sputum AFB (+), culture (+), PCR (+) | Pulmonary TB | Specific medication is not specified | Yes | No | Unclassifiable | Diarrhea after ICI; death from tumor progression |
| Van 2019 (25) | 56/F/Swiss | Lung adenocarcinoma | Chemo + RT + steroids | Nivolumab | 12 | New pulmonary nodules, right lung infiltration, lymphangitis carcinomatosa | Dyspnea, cough, weight loss | Sputum AFB (+) | Pulmonary TB | HREZ | Yes | Yes | Reactivation of LTBI | Diarrhea after ICI; death from tumor progression |
| Elkington 2018 (26) | 62/F/ British |
Uveal melanoma | None | 1. Ipilimumab 2. Pembrolizumab; stable for ~2 years |
24 | Apical cavitary lesion | No specific TB-related symptoms | BAL culture (+); liver & lung histology | Disseminated TB (lung, liver) | Specific medication is not specified | Yes | No | Unclassifiable | Symptoms improved; lesions regressed |
| Lin 2023 (27) | 68/M/ Chinese |
Lung squamous cell carcinoma | Chemotherapy | Camrelizumab, 1 cycle | 1 | Increased multiple small nodules, patchy opacities and infiltrates in bilateral lungs | Cough, sputum, chest distress, dyspnea, hemoptysis | BAL PCR (+), AFB (+) | Pulmonary TB | HREZ | Yes | No | New primary infection | TB lesions resolved; tumor stable |
| Tetikkurt 2018 (28) | 53/M/ Turkish |
Maxillary squamous cell carcinoma | Chemo + RT | Pembrolizumab, 6 cycles | 4 | Chest CT consistent with TB infection | No specific TB-related symptoms | PCR (+); typical radiologic features of TB | Pulmonary TB | Specific medication is not specified | Yes | Yes | Reactivation of LTBI | TB controlled; tumor shrank after ICI |
| Hirano 2024 (29) | 67/M/ Japanese |
Lung adenocarcinoma | Chemotherapy | Nivolumab + ipilimumab | 1 | Initial: cavity near primary lesion in right upper lung; recurrence: diffuse left lung infiltration + right upper lung cavity | Initial: increased sputum; recurrence: anorexia, impaired consciousness | Sputum culture (+), AFB (+), PCR (+); identical strain by VNTR | Pulmonary TB | Initial: HREZ; Recurrence: Isoniazid, Rifampicin, Levofloxacin, Streptomycin | Yes | Yes | Reactivation of LTBI | Sputum negative; TB recurrence; death from respiratory failure |
| Suo 2023 (30) | 44/M/ Chinese |
Esophageal squamous cell carcinoma | Chemo + RT | Tislelizumab, 15 cycles | 10 | Multiple reversed halo signs and consolidations in bilateral lungs | Low-grade fever, cough, non-purulent sputum, exertional dyspnea, hypoxemia | BAL MTB detected by NGS | Pulmonary TB | HREZ | Yes | No | Unclassifiable | Lesions resolved; symptoms improved |
| Yang 2025 | 72/M/ Chinese |
Lung squamous cell carcinoma | Chemotherapy | 1.Sintilimab, 4 cycles 2.tislelizumab, 10 cycles |
13 | Bilateral pulmonary inflammation, increased right lung lesions | No specific TB-related symptoms | BAL Xpert MTB/RIF (+), culture (+) | Pulmonary TB | 2HREZ/4HR | Yes | No | Reactivation of LTBI | On ATT; liver metastasis; sudden death from cerebral hemorrhage |