title: Tuberculosis in a patient on temozolomide: a case report.
abstract: Temozolomide (TMZ) is a cytotoxic agent of the imidazotetrazine class, chemically related to dacarbazine. Its use poses higher risks of lymphopenia and opportunistic infections. Prophylaxis for Pneumocystis jiroveci must be considered up to 12 months after treatment discontinuation. The due literature (MEDLINE) makes no mention of a possible connection between the use of TMZ and tuberculosis (TB). A female patient, aged 59, featuring glioblastoma multiforme and having undergone solely a brain biopsy, was submitted to TMZ along with radiotherapy. After the first TMZ maintenance cycle, the referred patient was admitted displaying a background of a 40-day afternoon fever and productive coughing. She was thus submitted to a bronchoscopy and LBA, which resulted BAAR 1+/4+. TMZ was then suspended, and rifampicin, isoniazid, and pyrazinamide introduced. Considerations on prophylaxis with isoniazide in cancer patients are long-lived and scarce. Some subgroups are likely to benefit from the prophylactic administration of isoniazide during TMZ treatment, such as those patients under high doses of corticoids, patients with past medical history of TB, the malnourished, patients from endemic regions, and patients with highly reactive tuberculinic tests. That, nevertheless, must not restrict the administration of TMZ, but, rather, stand for a warning about its possible toxicity, and thus mitigate complications.
authors.affiliation: Department of Oncology, Treatment and Research Center, Hospital A. C. Camargo, Rua Prof. Antônio Prudente, 211, CEP 01509-900, Liberdade, SP, Brazil.
authors.forename: Tadeu Ferreira
authors.initials: TF
authors.lastname: de Paiva
authors.forename: Milton José
authors.initials: MJ
authors.lastname: de Barros e Silva
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Rinck
authors.forename: Marcello Ferreti
authors.initials: MF
authors.lastname: Fanelli
authors.forename: Daniel Luiz
authors.initials: DL
authors.lastname: Gimenes
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D000069059:Atorvastatin; D001932:Brain Neoplasms / Q000188:drug therapy; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000627:therapeutic use; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives*; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D005909:Glioblastoma / Q000188:drug therapy; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007538:Isoniazid / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010634:Phenobarbital / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011718:Pyrazinamide / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D011878:Radiotherapy; D012010:Red-Cell Aplasia, Pure / Q000188:drug therapy; D012293:Rifampin / Q000627:therapeutic use; D000077204:Temozolomide; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014397:Tuberculosis, Pulmonary / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D000897:Anti-Ulcer Agents; D000904:Antibiotics, Antitubercular; D000924:Anticholesteremic Agents; D000927:Anticonvulsants; D018906:Antineoplastic Agents, Alkylating; D006538:Heptanoic Acids; D007166:Immunosuppressive Agents; D011758:Pyrroles; D005473:Fluoxetine; D011718:Pyrazinamide; D003606:Dacarbazine; D003907:Dexamethasone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D016572:Cyclosporine; D000069059:Atorvastatin; D009853:Omeprazole; D007538:Isoniazid; D011241:Prednisone; D012293:Rifampin; D000077204:Temozolomide; D010634:Phenobarbital