Laryngeal Tuberculosis in a Patient on Avelumab for Metastatic Nasopharyngeal Carcinoma.

Increasing numbers of head and neck cancer patients are placed on immune checkpoint inhibitors for indications such as recurrent and metastatic disease. There is a theoretical increased risk of contracting and reactivation of tuberculosis (TB) with programmed cell death-1 blockade due to potentiation of type 1 T helper response and increased production of interferon-gamma. This is a potentially life-threatening complication of therapy and requires expedient diagnosis and treatment. We present a case of a patient with metastatic nasopharyngeal carcinoma treated with avelumab, a programmed cell death-ligand 1 inhibitor with resulting laryngeal TB as the presenting symptom of reactivated TB. The patient required quadruple anti-TB therapy, but developed ongoing sequelae of laryngeal TB, including dysphagia and laryngeal stenosis. Ongoing trials are examining the use of avelumab in head and neck cancer patients with locally advanced disease, recurrent, or metastatic disease. Awareness of the risk of new and reactivated TB is crucial.