Parvovirus B19 Infection in a Child with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy / 임상소아혈액종양

Parvovirus B19 targets human erythroid progenitor cells, causing a self-limiting subclinical erythroid aplasia in the healthy hosts, whereas the immunocompromised subjects generate a prolonged viremia and chronic anemia with or without thrombocytopenia or neutropenia. The attenuated immune response in patients with acute lymphoblastic leukemia (ALL), receiving chemotherapy, may generate the hematologic aberration which mimic a leukemia relapse or therapy-induced cytopenia. This mimicry may lead to the unnecessary examination and the recess of chemotherapy. If the anemia with or without thrombocytopenia or neutropenia is noticed during the chemotherapy of ALL, the parvovirus B19 infection should be considered as a cause of hematologic aberration. We report a case of parvovirus B19 infection confirmed by PCR in a child with ALL who was initially sero-negative (IgM and IgG) against parvovirus B19 to highlight the importance of alertness to the possibility of parvovirus B19 infection during chemotherapy.

Parvovirus B19 Infection in a Child with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy / 임상소아혈액종양

Parvovirus B19 targets human erythroid progenitor cells, causing a self-limiting subclinical erythroid aplasia in the healthy hosts, whereas the immunocompromised subjects generate a prolonged viremia and chronic anemia with or without thrombocytopenia or neutropenia. The attenuated immune response in patients with acute lymphoblastic leukemia (ALL), receiving chemotherapy, may generate the hematologic aberration which mimic a leukemia relapse or therapy-induced cytopenia. This mimicry may lead to the unnecessary examination and the recess of chemotherapy. If the anemia with or without thrombocytopenia or neutropenia is noticed during the chemotherapy of ALL, the parvovirus B19 infection should be considered as a cause of hematologic aberration. We report a case of parvovirus B19 infection confirmed by PCR in a child with ALL who was initially sero-negative (IgM and IgG) against parvovirus B19 to highlight the importance of alertness to the possibility of parvovirus B19 infection during chemotherapy.

Aspergilosis sinusal no invasiva por Aspergillus parasiticus en niño inmunocomprometido / Non invasive sinusal aspergillosis by Aspergillus parasiticus in an immunecompromised child

El presente trabajo tiene la finalidad de exponer un caso clínico de un niño inmunosuprimido con antecedentes de hospitalización previa, a los 6 años de edad con múltiples síntomas y signos (poliadenopatías, desnutrición, sepsis en cavidad bucal y foco pulmonar, además de pancitopenia). Permaneció en terapia intermedia durante 38 días, cumpliendo varios esquemas antibióticos sin buena respuesta a los mismos. Fue derivado al Hospital Ricardo Gutiérrez (Buenos Aires) desconociéndose la terapéutica seguida en esa oportunidad. Cinco años después (2007) es ingresado nuevamente a nuestro hospital por cuadro de epistaxis cefaléa, compromiso del estado general y neutropenia febril, por lo que se inicia tratamiento antibiótico, además de estudio con mielograma confirmándose el diagnóstico de leucemia linfocítica aguda. Cinco días después de su ingreso expulsa espontáneamente, desde las fosas nasales material granulomatoso el cual fue enviado a estudio micológico (examen directo y cultivo), detectándose alta presencia de Aspergillus parasiticus en ambos exámenes, lo cual fue ratificado por histopatología como una aspergilosis sinusal no invasiva. El paciente fue remitido a la Sala de Inmunodeprimidos donde recibió tratamiento intravenoso con 350 mg/día de anfotericina B-complejo lipídico y terapia específica para LLA. Presentó una evolución tórpida y al 12º día el paciente falleció por su mal estado general y progresión terminal de su enfermedad de base.

This present paper is meant to reveal the clinical case of an immunesuppressed boy having been previously in a hospital, when he was 6, showing multiple symptoms and signs (polyadenopaties, malnutrition, buccal sepsis and pulmonary focus, in addition to pancitopia). He stayed under intermediate therapy for 38 day being submitted to varied antibiotic schemes, though yielding no satisfactory responses to them. Later on he was derived to the Hospital Ricardo Gutiérrez (Buenos Aires), yet therapeutics used at that place being unknown. Five years later (2007), he is admitted again in our hospital because of cephalea epistaxis, a compromised health condition and fevered neutropenia, so he is given an antibiotic treatment in addition to a mielographic studyyet it is confirmed the diagnosis of an acute lymphocytic leukemia. Five days after his admittance, he discharges granulomatous matter from his nasal cavities which was sent for a mycological study. Direct exam and culture, detecting high presence of Aspergillus parasiticus on both exams which was ratified by histopathology as a non invasive sinusal aspergillosis. The patient was sent to the Immunedepressed Ward where he received intravenous treatment with 350mg/day anfotericina Blipidic complex and a specific therapy for LLA. He had a torpid evolution and on the 12nd day the patient died as a result of his very bad health condition as well as the terminal progression of his base disease.