[Interstitial pneumopathies in children treated for malignant diseases]

The authors report 21 cases of severe interstitial pneumonitis observed in 1974 in Paris, in children with malignancies, either solid tumours or leukemias. Twelve patients died. The incidence of these complications in children with intensive chemotherapy and the clinical symptoms which may reveal them are reviewed; the bad prognosis of measles in these patients is stressed. Radiological findings are described and the possible wrong diagnoses are listed. Among viral infections, measles is the severest and its diagnosis is often difficult. Pneumocystis carinii infection is frequent. The use of surgical pulmonary biopsy and other diagnostic procedures is discussed. The immune status of these patients has been studied, which revealed severe impairement of cellular immunity, including low lymphocyte count, while humoral immunity was not changed. Symptomatic treatment may include oxygen supply and mechanical respiratory help, dietary management, and attempts towards non specific immune system stimulation. Aetiologic treatment is essentially the treatment of Pneumocystis carinii, which is discussed. Diagnosis and treatment of pneumonitis in immunosuppressed patients being very difficult, emphasis is made on the prevention of this accident, including caution in the handling of chemotherapy protocols.