A 9-year old Argentinean girl had been diagnosed with acute lymphoblastic leukaemia in 1999 and was successfully treated with the ALL 96/BFM protocol. In February 2004, following the development of secondary acute myeloid leukaemia, the girl was treated with the AML 97/BFM protocol and obtained a complete remission. In October 2004 she was transferred to Italy in the Unit of Paediatric Haematology/Oncology in Pisa to undergo an allogeneic BMT from a matched, unrelated donor. The pre-transplant evaluation (including electrocardiography and echocardiography) was normal, except for a known cerebral atrophy. A conditioning regimen (fractioned total body irradiation, cyclophosphamide, anti-thymocyte globulin) was administered and 4.34×108/kg of haematopoietic stem cells were infused. Graft-versus-Host Disease (GvHD) prophylaxis was given (cyclosporine A and short course of methotrexate). Polymorphonuclear leucocyte and platelet engraftment occurred on day +20 and +28, respectively. Treatment with prednisolone was started on day +26 because of grade II GvHD of the skin. On day +46 the patient was found to have fever with progressive anaemia (lowest haemoglobin level 7.9 g/dL), neutropenia (180 neutrophils/μL) and thrombocytopenia (12,000 platelets/μL), increased lactate dehydrogenase (1,330 U/L) and alanine transaminase (120 U/L) and mildly increased C-reactive protein (59 mg/L). Clinical examination was non-informative and blood, urine and cerebrospinal fluid cultures were negative. Bone marrow aspiration confirmed the leukaemia remission. Echocardiography and total body computed tomography scans were normal. Broad-spectrum antibiotics were started and antifungal therapy was added 5 days later. Epstein-Barr virus reactivation on day +46 was successfully treated with rituximab, with normalisation of virological markers but no effect on the fever. On day +56 the patient’s general conditions worsened and she developed hepatomegaly and laboratory evidence of abnormal liver function (gamma-glutamyl transferase 425 U/L, alanine transaminase 232 U/L, alkaline phosphatase 830 U/L, lactate dehydrogenase 11,526 U/L). A peripheral blood smear revealed flagellated parasites identified as T. cruzi trypomastigotes. Therapy with benznidazole (10 mg/kg/die) was started but 3 days later the patient died from multi-organ failure (day +70).
Reactivation of Chagas disease after a bone marrow transplant in Italy: first case report
Bisoffi Z;
2012-01-01
Abstract
A 9-year old Argentinean girl had been diagnosed with acute lymphoblastic leukaemia in 1999 and was successfully treated with the ALL 96/BFM protocol. In February 2004, following the development of secondary acute myeloid leukaemia, the girl was treated with the AML 97/BFM protocol and obtained a complete remission. In October 2004 she was transferred to Italy in the Unit of Paediatric Haematology/Oncology in Pisa to undergo an allogeneic BMT from a matched, unrelated donor. The pre-transplant evaluation (including electrocardiography and echocardiography) was normal, except for a known cerebral atrophy. A conditioning regimen (fractioned total body irradiation, cyclophosphamide, anti-thymocyte globulin) was administered and 4.34×108/kg of haematopoietic stem cells were infused. Graft-versus-Host Disease (GvHD) prophylaxis was given (cyclosporine A and short course of methotrexate). Polymorphonuclear leucocyte and platelet engraftment occurred on day +20 and +28, respectively. Treatment with prednisolone was started on day +26 because of grade II GvHD of the skin. On day +46 the patient was found to have fever with progressive anaemia (lowest haemoglobin level 7.9 g/dL), neutropenia (180 neutrophils/μL) and thrombocytopenia (12,000 platelets/μL), increased lactate dehydrogenase (1,330 U/L) and alanine transaminase (120 U/L) and mildly increased C-reactive protein (59 mg/L). Clinical examination was non-informative and blood, urine and cerebrospinal fluid cultures were negative. Bone marrow aspiration confirmed the leukaemia remission. Echocardiography and total body computed tomography scans were normal. Broad-spectrum antibiotics were started and antifungal therapy was added 5 days later. Epstein-Barr virus reactivation on day +46 was successfully treated with rituximab, with normalisation of virological markers but no effect on the fever. On day +56 the patient’s general conditions worsened and she developed hepatomegaly and laboratory evidence of abnormal liver function (gamma-glutamyl transferase 425 U/L, alanine transaminase 232 U/L, alkaline phosphatase 830 U/L, lactate dehydrogenase 11,526 U/L). A peripheral blood smear revealed flagellated parasites identified as T. cruzi trypomastigotes. Therapy with benznidazole (10 mg/kg/die) was started but 3 days later the patient died from multi-organ failure (day +70).
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
