Cytomegalovirus Proctitis in a Patient with Chronic Lymphocytic Leukemia on Ibrutinib Therapy: A Case Report

Abstract

Ibrutinib is a Bruton tyrosine kinase (BTK) inhibitor that has shown significant efficacy in patients with lymphoid carcinomas, mostly chronic lymphocytic leukemia (CLL). Cytomegalovirus (CMV) infection is not a common infectious complication associated with ibrutinib. To increase the clinical awareness about this rare entity, we present the first case of CMV proctitis in an immunocompromised host who was being treated with ibrutinib. An 88-year old female with a history of CLL treated with ibrutinib presented with two days of painless hematochezia. Physical examination revealed cachexia and temporal wasting; bright red blood was observed on the digital rectal examination. A complete blood count demonstrated a significant decrease in hemoglobin from her baseline. Subsequent colonoscopy revealed a circumferential rectal ulcer; biopsy of the rectal ulcer was positive for CMV immunostain. The patient was treated with intravenous ganciclovir and later transitioned to valganciclovir for a total of 21 days of treatment. Her condition resolved, and she was found doing well at the follow-up visit.

Effects of B-Cell Lymphoma on the Immune System and Immune Recovery after Treatment: The Paradigm of Targeted Therapy

“…However, the increased susceptibility to infection seems to be due to a number of additional factors, such as previous lines of chemotherapies, neutropenia and concomitant steroid therapy. Finally, the emergence of infectious complications during ibrutinib therapy appears to be concentrated especially in the first 6–12 months of treatment [ 87 , 88 , 89 ]. In patients with CLL, cytomegalovirus end-organ disease has been anecdotally reported [ 90 ].…”

Cytomegalovirus‐specific T‐cell immunity and DNAemia in patients with chronic lymphocytic leukaemia undergoing treatment with ibrutinib

“…Ibrutinib targets Bruton tyrosine kinase (BTK), which plays a major role in B‐ and T‐cell proliferation and survival 2 and recognition of infectious agents by the innate immune system 3 . Ibrutinib therapy has been associated with an increased incidence of several opportunistic infections, especially in the first 6–12 months after therapy initiation, 4–7 among which cytomegalovirus (CMV) end‐organ disease has been anecdotally reported 8 . Nevertheless, little is known about the biology of CMV in ibrutinib‐treated patients.…”

“…3 Ibrutinib therapy has been associated with an increased incidence of several opportunistic infections, especially in the first 6-12 months after therapy initiation, [4][5][6][7] among which cytomegalovirus (CMV) end-organ disease has been anecdotally reported. 8 Nevertheless, little is known about the biology of CMV in ibrutinib-treated patients. In our opinion, this is a relevant topic to explore in light of the well-established association between the CMV DNAemia and increased overall mortality in allogeneic haematopoietic stem cell transplant recipients, 9 which may potentially stand in other clinical settings.…”

“…Carlos Solano de la Asunci on 1 Mar ıa Jos e Terol 2,3 Ana Saus 2 Beatriz Olea 1 Estela Gim enez 1 Eliseo Albert 1 Javier L opez-Jim enez 4 Rafael Andreu 5 Dolores Garc ıa 6 Laura Fox 7 Mar ıa Jos e Remigia 2 Paula Amat 2,3 Carlos Solano 2,3 David Navarro 1,8…”

Cytomegalovirus in Haematological Tumours

“…CMV infection is not common in the case of a BTK inhibitor such as ibrutinib, although some cases have been reported ( 121 ). Although these are infrequent, we should always be aware of this possibility among immunocompromised patients, particularly those who have been treated with new agents, because this is a curable condition and early therapy seems to be critical if a good outcome is to be achieved.…”