Pulmonary Tuberculosis following Chemotherapy for Metastatic Testicular Germ Cell Tumor: Possible Reactivation of Latent Tuberculosis Infection

Testicular germ cell tumors (TGCTs) are the most common solid malignancies in young adult men. Advanced disease requiring systemic chemotherapy may lead to immunosuppression and increase vulnerability to opportunistic infections, particularly in tuberculosis (TB)-endemic regions. Coexistence of visceral metastases and infectious comorbidities such as pulmonary TB can substantially complicate diagnostic evaluation and therapeutic decision-making. Latent TB infection (LTBI) reactivation following chemotherapy is a recognized but likely underreported complication in patients with solid tumors, posing additional clinical challenges. A 41-year-old male with a history of mixed TGCT who had undergone radical orchiectomy followed by platinum-based chemotherapy, presented with chronic cough, weight loss, and neurological symptoms. Imaging revealed a large pulmonary mass and a cerebral lesion consistent with metastases. Further evaluation confirmed pulmonary and brain metastases of TGCT origin. Pulmonary TB was bacteriologically confirmed by bronchoalveolar lavage GeneXpert. He received anti-TB therapy, supportive neurological treatment, and delayed neurosurgery after stabilization. Temporal association between prior chemotherapy, significant immunosuppression, and active TB development raised the suspicion of LTBI reactivation. He was discharged in the stable condition with plans for oncologic restaging and second-line chemotherapy. This case highlights the diagnostic and therapeutic challenges posed by the coexistence of metastatic TGCT and pulmonary TB. In TB-endemic settings, clinicians should maintain a high index of suspicion for TB in immunocompromised cancer patients presenting with pulmonary lesions. Multidisciplinary management and careful timing of oncologic and anti-TB treatments are essential to optimize the outcomes, and possible reactivation of LTBI should be considered following chemotherapy.