Scientific article
Case report
OA Policy
English

Old Pathogens-New Patient Types : Infections in a CAR T-Cell Recipient. Could It Get Any More Complicated ?

Published inTransplant infectious disease, vol. 27, no. 5, e70093
Publication date2025-09
First online date2025-08-21
Abstract

The case discussed involves a 41-year-old Italian man who was a candidate for chimeric antigen receptor T-cell therapy (CAR-T) for mediastinal diffuse large B-cell lymphoma. His CAR-T treatment was postponed several times due to prolonged relapsing COVID-19 and new onset of pulmonary Mycobacterium tuberculosis diseases. After 11 weeks of antimycobacterial treatment, CAR T-cell therapy was performed, but complicated by cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Two months after CAR-T, the patient developed invasive pulmonary aspergillosis due to A. fumigatus. He was successfully treated with a 6-month course of antitubercular therapy and an 8-month course of antifungal therapy with isavuconazole. Lobectomy was performed due to episodes of severe hemoptysis. The challenging issues of diagnosis, choice, and management of treatments, including drug-drug interactions and length of therapy, are discussed.

Keywords
  • Adult
  • Antifungal Agents / therapeutic use
  • Antitubercular Agents / therapeutic use
  • Aspergillus fumigatus / isolation & purification
  • COVID-19 / complications
  • COVID-19 / immunology
  • Cytokine Release Syndrome / etiology
  • Humans
  • Immunotherapy, Adoptive / adverse effects
  • Invasive Pulmonary Aspergillosis / diagnosis
  • Invasive Pulmonary Aspergillosis / drug therapy
  • Invasive Pulmonary Aspergillosis / immunology
  • Invasive Pulmonary Aspergillosis / microbiology
  • Lymphoma, Large B-Cell, Diffuse / immunology
  • Lymphoma, Large B-Cell, Diffuse / therapy
  • Male
  • Mediastinal Neoplasms / therapy
  • Neurotoxicity Syndromes
  • Nitriles / therapeutic use
  • Pyridines / therapeutic use
  • Receptors, Chimeric Antigen / immunology
  • SARS-CoV-2
  • Triazoles / therapeutic use
  • Tuberculosis, Pulmonary / drug therapy
Citation (ISO format)
MELCHIO, Monica et al. Old Pathogens-New Patient Types : Infections in a CAR T-Cell Recipient. Could It Get Any More Complicated ? In: Transplant infectious disease, 2025, vol. 27, n° 5, p. e70093. doi: 10.1111/tid.70093
Main files (1)
Article (Published version)
Identifiers
Journal ISSN1398-2273
10views
55downloads

Technical informations

Creation12/01/2026 14:35:55
First validation27/01/2026 16:01:33
Update27/01/2026 16:01:33
Status update27/01/2026 16:01:33
Last indexation27/01/2026 16:06:03
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack