At the crossroads of infection and malignancy: the challenge of tuberculosis in migrating populations – Case Report and Epidemiologic Analysis

Abstract Introduction Mycobacterium tuberculosis infection might result in fatal outcome in patients with haematologic malignancies or those with primary or iatrogenic immunodefects. However, in countries with low tuberculosis (TB) incidence the awareness for TB is still challenging, with an increasing need due to migrating populations from regions with high TB to low TB incidence countries. Case report and epidemiological analysis A 52-year-old caucasian female, refugee from Afghanistan, presented at University Hospital Charité (Berlin, Germany) with progressive left-sided hearing loss due to ear canal obstruction as well as right axillary exophytic and ulcerating skin lesions, finally diagnosed as BRAF-V600E-mutated Langerhans cell histiocytosis (LCH). Following systemic chemotherapy, LCH showed complete remission (CR) with however unexpectedly progressive left-axillary lymphadenopathy. Biopsy of these lymph nodes revealed granulomatous inflammation with central caseous necroses. Mycobacterium tuberculosis DNA was undetectable in a biopsy from the lesion, but culture of fresh re-biopsy material showed growth of M. tuberculosis. Given the patient´s migration history from a high-prevalence (Afghanistan) to a low-prevalence (Germany) TB country, we also present the long-time trend of the total number of TB patients notified in Germany in 2002–2023, i.e. a total of 21 years, aggregated by country of birth. Whereas the number of TB patients born in Germany is decreasing since 2002, the number of patients born abroad exceeded the number of those born in Germany in 2012, and remained higher ever since. Conclusion Our report highlights the challenge to treat patients at the crossroads of malignancy and TB, and the need for appropriate attention and awareness of physicians of the increased TB risk in people migrating from a high- to a low-burden TB country. Also, the case demonstrates once more the high value of culture for diagnosis of mycobacteria infection. Clinical Trial Not applicable.