We describe the case of a 70-year-old never smoker with chronic lymphocytic leukaemia, treated with single agent ibrutinib therapy. Chest imaging noted nodular change and mediastinal lymphadenopathy, which showed avid uptake on positron emission tomography and guided subsequent biopsies (bronchoscopy using endobronchial ultrasound, mediastinoscopy). Despite negative aspergillus blood immunology tests, he was found to have invasive aspergillosis, which is a known risk with ibrutinib therapy. He has since been successfully treated with antifungal therapy.
WeberANRBittnerZLiuX, et al. Bruton’s tyrosine kinase: an emerging key player in innate immunity. Front Immunol2017; 8: 1454.
2.
BercussonAColleyTShahA, et al. Ibrutinib blocks Btk-dependent NF-kB and NFAT responses in human macrophages during Aspergillus fumigatus phagocytosis. Blood2018; 132: 1985–8.
3.
FürstenauMSimonFCornelyOAet al. Invasive Aspergillosis in Patients Treated With Ibrutinib. HemaSphere2020;4(2): e30.
