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Fatal Mycobacterium avium complex disease in a patient with acute nonlymphoblastic leukemia
L Martinez-Arroyo1, J T Ramos Amador, E Cela de Julian
1Division of Pediatric Intensive Care, Hospital Materno-Infantil, Madrid, Spain.
Purpose:
The objective of this article was to present the diagnosis of a fatal infection by Mycobacterium avium complex (MAC) in a child with acute myelogenous leukemia, a disease rarely reported in non-HIV infected children.
Methods:
Specific identification of MAC was made by culture in BACTEC system from an open lung biopsy.
Results:
A 5-year-old girl diagnosed with acute nonlymphoblastic leukemia was admitted because of fever during the maintenance phase after achieving a complete remission of her malignancy. A mild dry cough started on day 4 of admission, and a chest roentgenogram revealed a pulmonary infiltrate. An insidious respiratory distress developed and mechanical ventilation was undertaken. An open-lung biopsy, carried out on day 10 of ventilatory support, revealed acid-fast bacilli subsequently grown as MAC. In spite of combined antimycobacterial treatment, the patient followed a downhill course and died on day 41 of hospitalization.
Conclusion:
This report describes a new case of fatal MAC infection in an immunocompromised, non-HIV infected child. MAC must be added to the list of infectious microorganisms that can infect children with acute nonlymphoblastic leukemia. As modern immunosuppressive therapeutic modalities evolve, it is likely that MAC will become a more common and recognized pathogen in the immunocompromised child.