Renal tuberculosis in an imatinib-treated chronic myeloid leukemia

ABSTRACT Imatinib, which inhibits tyrosine kinase activity of Bcr-Abl protein, is a standard form of treatment for chronic myeloid leukemia (CML). Through its immunomodulatory effect it affects T cell function in a number of ways. It inhibits antigen-induced T cell activation and proliferation. Antigen-specific T-cells and macrophages are vital for protection against Mycobacterium tuberculosis. Here we present a case of renal tuberculosis associated with imatinib therapy in the maintenance phase of CML. With granulomatous interstitial nephritis and positive tubercular DNA on renal biopsy, the condition was successfully treated with anti-tubercular therapy. This case provides support to the hypothesis that imatinib therapy in CML increases the susceptibility to tuberculosis and strict vigilance is required to enable its early detection and treatment.摘要：伊马替尼（Imatinib）可抑制Bcr-Abl蛋白的酪氨酸激酶活性，是慢性髓系白血病（chronic myeloid leukemia, CML）的标准治疗方案。其通过免疫调节作用以多种途径影响T细胞功能，可抑制抗原诱导的T细胞活化与增殖。抗原特异性T细胞与巨噬细胞对于抵御结核分枝杆菌（Mycobacterium tuberculosis）感染至关重要。本文报告1例处于慢性髓系白血病维持治疗阶段的患者，在接受伊马替尼治疗期间并发肾结核。该患者肾活检提示肉芽肿性间质性肾炎，肾组织结核DNA检测呈阳性，经抗结核治疗后病情得到成功控制。本病例支持以下假说：慢性髓系白血病患者接受伊马替尼治疗会增加结核感染的易感性，因此需严格监测以实现早期发现与治疗。