ABSTRACT
A 4-year-old female child developed cutaneous Langerhans cell histiocytosis 6 months following a diagnosis of T-cell acute lymphoblastic leukemia. Imaging revealed no evidence of systemic disease. Seven months later, the first systemic lesion was discovered on laryngoscopy. Restaging Positron Emission Tomography - Computed Tomography at that time revealed new 18-fluorodeoxyglucose-positive lesions in the left apical pleural margin, right lower peri-esophageal region, left ventricular myocardium, pancreas, upper pole of the left kidney, and inguinal and gluteal regions consistent with progressive systemic disease. Genomic testing revealed a low tumor mutational burden as well as mutations in KRAS G12A, ARID1A Q524, CDKN2A/B loss, and an alteration in NOTCH1.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Histiocytosis, Langerhans-Cell/pathology , Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Child, Preschool , Fatal Outcome , Female , Histiocytosis, Langerhans-Cell/chemically induced , Humans , Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/pathologyABSTRACT
BACKGROUND: Despite advances in the treatment of sickle cell disease (SCD) in pediatric and young adult patients, pain remains a significant cause of disease-related morbidity. Physical therapy has been shown to be useful for the treatment of pain in young patients with chronic illnesses, however, limited data exists regarding potential benefits of physical therapy in patients with SCD. MATERIALS AND METHODS: We conducted a web-based survey of health care providers and support staff in the New England area to identify potential benefits of and barriers to outpatient physical therapy in this patient population. RESULTS: Nearly 92% of survey participants felt that physical therapy had the potential to be beneficial in pediatric and young adult patients with SCD. A majority of physicians reported having referred patients with SCD for physical therapy. Perceived potential benefits included improved functional mobility, improved chronic pain symptoms, decreased opiate use, improved mood symptoms, improved acute pain symptoms, and improved adherence with medications and clinic visits. Significant perceived barriers identified included lack of transportation, time constraints, patient lack of understanding, and difficulty with insurance coverage. CONCLUSIONS: Health care providers have a positive view of the use of physical therapy in the management of this patient population. Significant barriers exist which need to be addressed.
