Sorafenib-induced tuberculosis reactivation

Abstract

Background: Sorafenib is a multikinase inhibitor with an established role in treating renal cell carcinoma and hepatocellular carcinoma. In vivo studies have demonstrated sorafenib's inhibitory effects on various immune cells and cytokines which are essential to the maintenance of latency of granulomas in patients with latent tuberculosis infection.

Case report: A 74-year-old male with clear cell renal cell carcinoma with pulmonary metastases was treated with sorafenib to good effect. However, he developed productive cough, sweats and weight loss. A computed tomography scan of the thorax demonstrated right lower lobe consolidation and cavitation. Sputum analysis was positive for tuberculous smear and culture. A diagnosis of sorafenib-induced tuberculosis reactivation was made. Sorafenib was held and anti-tuberculous antibiotics were commenced, which led to symptomatic and radiographic improvement.

Conclusion: The authors postulate that sorafenib could increase the risk of progression from latent to active tuberculosis, and urge vigilance and possible screening for latent tuberculosis in patients who are treated with sorafenib.