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Fungal pneumonias masquerading as thromboses during induction therapy of acute lymphoblastic leukemia

A D Pearson1, M E Nesbit, P J Darbyshire

  • 1Department of Pediatrics, University of Minnesota, School of Medicine, Minneapolis.

Pediatric Hematology and Oncology
|January 1, 1986
PubMed

Insights

Fatal fungal pneumonias occurred in two children with acute lymphoblastic leukemia (ALL) during treatment. Symptoms mimicked L-asparaginase-induced thrombosis, highlighting the need to consider fungal infections in neutropenic children.

Area of Science:

  • Pediatric Oncology
  • Infectious Diseases
  • Hematology

Background:

  • Acute lymphoblastic leukemia (ALL) treatment often involves immunosuppression.
  • Remission induction therapy can lead to neutropenia.
  • L-asparaginase is a key chemotherapeutic agent used in ALL treatment.

Observation:

  • Two pediatric patients with ALL developed fatal fungal pneumonias during remission induction.
  • Clinical signs in both patients suggested L-asparaginase-induced multiple-thromboses syndrome.
  • Patients were neutropenic and receiving broad-spectrum antibiotics.

Findings:

  • Fungal pneumonia can present with pulmonary and central nervous system symptoms.
  • These symptoms can mimic thrombotic events, complicating diagnosis.
  • The underlying immunosuppression and L-asparaginase treatment likely contributed to the fungal infections.

Implications:

  • Fungal infections should be strongly considered in neutropenic children with ALL experiencing pneumonia.
  • The possibility of fungal pneumonia must be evaluated when multiple thromboses occur in this patient population.
  • Early recognition and treatment of fungal infections are crucial for improving outcomes in pediatric ALL patients.

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