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Pythium insidiosum pleuropericarditis complicating pneumonia in a child with leukemia
John A Heath1, Timothy E Kiehn, Arthur E Brown
1Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10021, USA.
Insights
A boy with acute myeloid leukemia developed a rare Pythium insidiosum infection of the pleuropericardium during neutropenia. Antifungal therapy led to remission, highlighting a potential treatment for this aggressive infection.
Area of Science:
- Mycology
- Hematology
- Infectious Diseases
Background:
- Acute myeloid leukemia (AML) treatment often leads to neutropenia, increasing infection risk.
- Pleuropericarditis is a serious condition involving inflammation of the lung lining and heart sac.
- Invasive fungal infections are a significant concern in immunocompromised patients.
Observation:
- A 12-year-old boy with AML developed pleuropericarditis during neutropenia while on antibiotics and antifungals.
- Diagnostic procedures revealed fungal hyphae in purulent material from the pleuropericardial space.
- Cultures identified the causative organism as Pythium insidiosum.
Findings:
- Pythium insidiosum, an oomycete, can cause invasive infections in immunocompromised hosts.
- Aggressive diagnostic and therapeutic pleuropericardial drainage was performed.
- A 12-month course of intravenous liposomal amphotericin B and itraconazole was administered.
Implications:
- This case highlights Pythium insidiosum as a potential pathogen in neutropenic patients with leukemia.
- Successful treatment with liposomal amphotericin B and itraconazole suggests a viable therapeutic strategy.
- Early diagnosis and aggressive management are crucial for improving outcomes in such rare invasive infections.
Abstract:
We describe a 12-year-old boy with acute myeloid leukemia who developed pleuropericarditis while he was neutropenic and was receiving intravenously administered antibiotic and antifungal therapy for pneumonia. A KOH preparation of the purulent material from an extensive diagnostic and therapeutic pleuropericardial drainage procedure revealed multiple irregularly septate hyphae, and cultures yielded the organism Pythium insidiosum. After completing a 12-month course of intravenously administered liposomal amphotericin B (AmBisome; Fujisawa Healthcare) and itraconazole, the patient remained alive, in clinical remission, and symptom free.