Sunitinib and TB lymphadenitis: An unexpected link in oncological therapy: a case report

Rationale: Gastrointestinal stromal tumors (GIST) are neoplasms that originate from the interstitial cells of cajal located in the muscular layer of the gastrointestinal tract. Surgery is the primary treatment options; however, if resection is not feasible, or in cases of metastatic or recurrent GIST, systemic chemotherapy can be considered as an alternative. Sunitinib, a multi-targeted tyrosine kinase inhibitor, is indicated as an essential second-line treatment for GIST following disease progression or intolerance to imatinib mesylate. It works by slowing down or stopping the growth of tumor cells through the inhibiting tyrosine kinases, including KIT and PDGFRα. Commonly reported side effects of sunitinib include hypertension, fatigue, neutropenia, and dermatologic reactions such as rash. Patient concerns: A patient diagnosed with relapsed malignant gastrointestinal stromal tumors (GIST) was treated with sunitinib for 15 months following the failure of imatinib treatment. The patient presented with neck pain and a fever of up to 38.8°C. Diagnoses and interventions: Upon evaluation, a palpable lymph node was biopsied, and pathology results confirmed tuberculosis (TB) lymphadenitis. Subsequently, TB medication was initiated, and 2 months after starting the treatment, significant improvement in lymphadenopathy was observed on the computed tomography scan. However, the patient experienced side effects during the treatment, including hepatotoxicity, visual disturbances, and a decreased platelet count, which led to discontinuation and a change in medication. Outcomes: The treatment lasted for a year, which was longer than that initially planned. Despite switching to third-line therapy for GIST, the disease progressed, and the patient eventually died. Lessons: Owing to the anti-angiogenic effect of sunitinb, infectious complications are very rare, and cases of tuberculosis-related side effects associated with sunitinib are almost unheard of. This case illustrates that TB lymphadenitis can occur as a rare adverse effect of sunitinib treatment.