mercaptopurine and Measles

We report the diagnostic and therapeutic challenges in an unusually fulminant presentation of measles, presenting as severe necrotizing bronchiolitis with secondary hemophagocytic lymphohistiocytosis (HLH) in the absence of classical clinical features in an immunocompromised host on maintenance chemotherapy. Our patient had presented with features of a viral pneumonitis without the classical exanthem, in combination with HLH. Although rhinovirus-induced HLH was highly unusual, the positive rhinovirus swab result had distracted us from the eventual diagnosis. This calls for greater impetus to increase awareness and public education to improve vaccination rates and herd immunity to curb outbreaks and protect the immunocompromised patients.

Topics: Adrenal Cortex Hormones; Anti-Infective Agents; Antineoplastic Combined Chemotherapy Protocols; Cryptogenic Organizing Pneumonia; Diagnostic Errors; Extracorporeal Membrane Oxygenation; Fatal Outcome; Humans; Lymphohistiocytosis, Hemophagocytic; Maintenance Chemotherapy; Male; Measles; Mercaptopurine; Methotrexate; Multiple Organ Failure; Pancytopenia; Picornaviridae Infections; Plasma Exchange; Pneumonia, Viral; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rhinovirus; Sepsis; Survivors

Topics: Brain Neoplasms; Child; Child, Preschool; Cross Infection; Cyclophosphamide; Drug Therapy, Combination; Female; Humans; Infant; Injections, Intravenous; Leukemia; Leukemia, Lymphoid; Male; Measles; Mercaptopurine; Methotrexate; Prednisolone; Remission, Spontaneous; Spinal Neoplasms; Vincristine

Topics: Abnormalities, Drug-Induced; Animals; Azathioprine; Busulfan; Carbutamide; Congenital Abnormalities; Cyclophosphamide; Female; Gestational Age; Humans; Lipid Metabolism; Maternal Age; Measles; Mercaptopurine; Mice; Morphogenesis; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Radiation Injuries; Rats; Thalidomide; Tolbutamide