ABSTRACT
Lymphomatoid granulomatosis, a rare condition in children, affects the lungs primarily but may have significant extrapulmonary manifestations, especially in the central nervous system. We report a case of lymphomatoid granulomatosis with onset after the completion of chemotherapy for childhood acute lymphoblastic leukemia. Two months after treatment ended, the 7-year-old girl developed splenomegaly, cervical adenopathy, and bilateral interstitial pulmonary infiltrates. She improved on cefotaxime but experienced a seizure 1 month later. A computed tomography scan of the head was normal, but her pulmonary infiltrates had become nodular. A computed tomography-guided biopsy of 1 of the nodules revealed cellular interstitial pneumonitis. One month later, she had persistent pulmonary infiltrates, marked splenomegaly, and new seizures. Magnetic resonance imaging of the head revealed cerebral nodules. Itraconazole was begun, and the pulmonary infiltrates resolved. Five months after her initial symptoms, she developed tonic pupil and a decreased level of consciousness. Dexamethasone was initiated. Needle biopsies of the brain were carried out, yielding the diagnosis of severe chronic inflammatory changes focally consistent with granuloma. The child redeveloped splenomegaly and fever, and then suffered an acute decompensation with hypoxemia, tachypnea, splenomegaly, and cardiac gallop. Open-lung biopsy revealed lymphomatoid granulomatosis. Lymphoma-directed therapy was initiated, and the patient had complete resolution of pulmonary and cerebral nodules 5 months later. No intrathecal chemotherapy was administered, and radiation therapy was not necessary. Neuropsychological testing obtained after completion of therapy revealed an improvement in attention, coordination, and fine motor speed over time. She is now in good health and attending school.
Subject(s)
Brain Neoplasms/diagnosis , Lung Neoplasms/diagnosis , Lymphomatoid Granulomatosis/diagnosis , Neoplasms, Second Primary/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Antineoplastic Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy , Brain Neoplasms/drug therapy , Child, Preschool , Female , Humans , Lung Neoplasms/drug therapy , Lymphomatoid Granulomatosis/drug therapy , Magnetic Resonance Imaging , Neoplasms, Second Primary/drug therapyABSTRACT
Investigated the prediction of cognitive and behavioral outcomes in 63 children with heterogenous brain tumors. Hierarchical multiple regression analyses were used to determine how family-related variables added to the prediction of children's outcome over and above illness measures. The best predictors of children's behavior problems and adaptive behavior were family and demographic variables, whereas the best predictors of achievement were illness and demographic variables. A combination of family and illness variables, however, was the best predictor of intellectual functioning. In addition to identifying specific predictors of cognitive and behavioral outcome in children with brain tumors, these results lend initial support for the inclusion of contextual factors such as family stress, maternal coping, number of parents in the home, and family SES measures in studies of how disease factors affect outcomes in pediatric brain tumor patients.
