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Acquired Immunodeficiency from Maternal Chemotherapy and Severe Primary Pneumocystis Infection in an Infant

Adeline Yi Ling Lim1, Adrian Christian Mattke2,3, Julia Elizabeth Clark4,5

  • 1Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, Queensland 4101, Australia.

Case Reports in Pediatrics
|April 8, 2020
PubMed

Insights

Severe Pneumocystis pneumonia (PCP) occurred in an infant with acquired immunodeficiency from maternal chemotherapy. The infant required extracorporeal membrane oxygenation (ECMO) for respiratory failure, emphasizing the need for postnatal surveillance.

Area of Science:

  • Immunology
  • Pediatrics
  • Infectious Diseases

Background:

  • Pneumocystis jirovecii is an opportunistic pathogen causing severe pneumonia in immunocompromised individuals.
  • Maternal chemotherapy during pregnancy can lead to fetal immunodeficiency.
  • Acquired combined immunodeficiency in infants presents significant clinical challenges.

Observation:

  • A case of severe Pneumocystis pneumonia (PCP) is presented in an infant with acquired combined immunodeficiency.
  • The immunodeficiency was secondary to maternal chemotherapy exposure during the second and third trimesters of pregnancy.
  • The infant experienced severe respiratory failure requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO).

Findings:

  • Infants exposed to maternal chemotherapy in utero are at risk for severe acquired immunodeficiency.
  • Pneumocystis pneumonia can manifest severely in neonates with iatrogenic immunodeficiency.
  • VV-ECMO may be necessary for cardiorespiratory support in severe cases of neonatal PCP.

Implications:

  • This case underscores the potential for severe acquired immunodeficiency in infants exposed to maternal chemotherapy.
  • Increased postnatal surveillance for opportunistic infections like PCP is crucial in this high-risk infant population.
  • Early recognition and management of immunodeficiency and subsequent infections are vital for improving outcomes.

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