PMID- 37083275
OWN - NLM
STAT- MEDLINE
DCOM- 20230424
LR  - 20230604
IS  - 1536-3678 (Electronic)
IS  - 1077-4114 (Linking)
VI  - 45
IP  - 4
DP  - 2023 May 1
TI  - Subcutaneous Microabscesses and Myositis as Part of Immune Reconstitution 
      Inflammatory Syndrome due to Chronic Disseminated Candidiasis in a Child With 
      Acute Lymphoblastic Leukemia.
PG  - e555-e559
LID - 10.1097/MPH.0000000000002640 [doi]
AB  - BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) occurs when there 
      is immune recovery after a prolonged period of leucopenia as a response to an 
      underlying latent or chronic infection due to a proinflammatory cascade. It can 
      occur in a child on chemotherapy for acute lymphoblastic leukemia (ALL) with 
      underlying chronic disseminated candidiasis (CDC). OBSERVATION: We present a 
      7-year-old girl with pre-B ALL on chemotherapy who had prolonged febrile 
      neutropenia and CDC with microabscesses in the liver, spleen, and kidney and a 
      prolonged intensive care unit stay. Upon neutrophil recovery, she continued to 
      have high-grade fever (blood and urine cultures negative). She also presented 
      severe myositis of bilateral thigh muscles and developed unusual granulomas in 
      the subcutaneous region of the lower back and right thigh. Although IRIS was 
      suspected, she could not be initiated on steroids due to right upper lobe 
      collapse consolidation due to multidrug-resistant Acinetobacter baumanni, which 
      was treated with sensitive antibiotics. Treatment with steroids resolved her 
      fever and normalized inflammatory markers. She is currently well on maintenance 
      chemotherapy. CONCLUSIONS: IRIS can complicate the treatment of ALL in children. 
      Diagnosing it while having a concurrent bacterial infection is challenging. 
      Rarely CDC can present with subcutaneous granulomas. Treatment with steroids at 
      the right time is very crucial.
CI  - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Reddy, Nalla A
AU  - Reddy NA
AD  - KMC Hospital.
FAU - Addala, Soundarya
AU  - Addala S
AD  - Department of Paediatrics, Kasturba Medical College, Mangalore.
AD  - Manipal Academy of Higher Education (MAHE), Manipal.
FAU - S S, Shyam
AU  - S S S
AD  - Department of Paediatrics, KVG Medical College, Sullia, Karnataka, India.
FAU - Lashkari, Harsha P
AU  - Lashkari HP
AD  - Department of Paediatrics, Kasturba Medical College, Mangalore.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20230228
PL  - United States
TA  - J Pediatr Hematol Oncol
JT  - Journal of pediatric hematology/oncology
JID - 9505928
SB  - IM
MH  - Female
MH  - Humans
MH  - Child
MH  - Persistent Infection
MH  - *Immune Reconstitution Inflammatory Syndrome/complications/drug therapy
MH  - Abscess
MH  - Fever/microbiology
MH  - *Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/drug therapy
MH  - *Candidiasis/complications/diagnosis/drug therapy
MH  - *Myositis
COIS- The authors declare no conflict of interest.
EDAT- 2023/04/21 12:42
MHDA- 2023/04/24 06:41
CRDT- 2023/04/21 08:13
PHST- 2022/07/12 00:00 [received]
PHST- 2022/12/17 00:00 [accepted]
PHST- 2023/04/24 06:41 [medline]
PHST- 2023/04/21 12:42 [pubmed]
PHST- 2023/04/21 08:13 [entrez]
AID - 00043426-202305000-00038 [pii]
AID - 10.1097/MPH.0000000000002640 [doi]
PST - ppublish
SO  - J Pediatr Hematol Oncol. 2023 May 1;45(4):e555-e559. doi: 
      10.1097/MPH.0000000000002640. Epub 2023 Feb 28.