mercaptopurine and Multiple-Organ-Failure

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

We describe a 4-year-old female with pre-B-cell acute lymphoblastic leukemia on maintenance chemotherapy, who developed hemophagocytic lymphohistiocytosis (HLH) secondary to Epstein-Barr virus (EBV) infection, complicated by an aggressive lymphoproliferative disorder. Although there was no history of bone marrow transplant or underlying immunodeficiency, EBV triggered a post-transplant lymphoproliferative disease (PTLD)-like lymphoma. Multiple regimens of chemotherapy failed to induce remission and patient developed multiorgan failure. The association of HLH with EBV-related PTLD-like lymphoproliferative disorder is rare. We present this case to highlight this unusual association so that this highly fatal disease can be recognized and promptly addressed.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Child, Preschool; Cyclosporine; Dexamethasone; Epstein-Barr Virus Infections; Etoposide; Female; Humans; Immunocompromised Host; Infant; Lymphohistiocytosis, Hemophagocytic; Male; Mercaptopurine; Methotrexate; Multiple Organ Failure; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rituximab; Treatment Failure; Vincristine; Viral Load

Disseminated adenoviral infection with hepatitis is rare in children undergoing standard chemotherapy. We report on a 3(1/2)-year-old male with fatal adenovirus hepatitis receiving maintenance chemotherapy for acute lymphoblastic leukemia (ALL). Adenoviral hepatitis was proven by histology, viral culture, and PCR in a liver biopsy. Quantitative real-time PCR in the peripheral blood showed adenoviral DNA copy number >10(9)/ml. Despite aggressive supportive care and antiviral treatment with cidofovir, the patient died rapidly due to fulminant liver failure. Diagnostic and treatment options for adenovirus infection remain unsatisfactory for these patients. We propose suggestions for diagnosis and therapy.

Topics: Adenovirus Infections, Human; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Asparaginase; Child, Preschool; Cidofovir; Computer Systems; Cytosine; DNA, Viral; Fatal Outcome; Hepatitis, Viral, Human; Humans; Immunocompromised Host; Male; Mercaptopurine; Methotrexate; Multiple Organ Failure; Organophosphonates; Polymerase Chain Reaction; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Vincristine; Viremia

Langerhans cell histiocytosis (LCH) is an enigmatic disease usually occurring in children. Tumor lysis syndrome (TLS) is a clinical syndrome associated with severe metabolic derangement and oliguric acute renal failure. In this report, we present the clinical course of an infant with advanced LCH who had TLS develop after chemotherapy. Treatment with continuous arteriovenous hemofiltration resulted in effective control of serum uric acid, potassium, creatinine, phosphorus, and blood urea nitrogen levels in the blood.

Topics: Acute Kidney Injury; Allopurinol; Antineoplastic Combined Chemotherapy Protocols; Biomarkers; Blood Transfusion; Combined Modality Therapy; Disease Progression; Etoposide; Fatal Outcome; Female; Fluid Therapy; Hemofiltration; Histiocytosis, Langerhans-Cell; Humans; Infant; L-Lactate Dehydrogenase; Lymph Nodes; Mercaptopurine; Multiple Organ Failure; Neck; Orbital Diseases; Prednisolone; Sodium Bicarbonate; Temporal Bone; Tumor Lysis Syndrome; Uric Acid; Vinblastine; Vincristine