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Perforated jejunitis in a child with acute lymphoblastic leukemia treated with pegaspargase

Elizabeth R Tang1, Teresa Chapman1, Laura S Finn2

  • 1Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA 98105, USA.

Radiology Case Reports
|July 11, 2018
PubMed

Insights

Asparaginase in acute lymphoblastic leukemia treatment improves survival but can cause vascular thrombosis. A case of pediatric mesenteric ischemia, a rare complication, highlights the need for vigilance in patients receiving this therapy.

Area of Science:

  • Pediatric Oncology
  • Hematology
  • Gastroenterology

Background:

  • Asparaginase is a critical component in treating acute lymphoblastic leukemia (ALL), significantly improving pediatric survival rates.
  • Despite its efficacy, asparaginase is associated with serious complications, notably vascular thrombosis.
  • Understanding these risks is crucial for optimizing ALL treatment protocols.

Observation:

  • A 13-year-old boy with pre-T-cell ALL developed perforated jejunitis during asparaginase therapy.
  • The condition necessitated surgical resection of a segment of the small bowel.
  • Pathological examination revealed transmural ischemia, mesenteric venous and arterial thrombi, and cytomegalovirus (CMV) inclusions.

Findings:

  • The case demonstrates a rare but severe complication of asparaginase treatment: pediatric mesenteric ischemia.
  • Mesenteric ischemia in children is uncommon, making this presentation particularly noteworthy.
  • The co-occurrence of thrombosis and CMV suggests potential multifactorial etiology.

Implications:

  • This case underscores the importance of considering mesenteric ischemia in pediatric patients with ALL undergoing asparaginase treatment, especially with thrombotic events.
  • Early recognition and management of such complications are vital for patient outcomes.
  • Further research may elucidate the precise mechanisms linking asparaginase, thrombosis, and gastrointestinal complications in children.

Keywords:
Acute lymphoblastic leukemiaAcute mesenteric ischemiaAsparaginaseComplicationsComputed tomographyPediatric

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