TAILIEUCHUNG - Two childrenwith di¡ering outcomes after treatment for pulmonary tuberculosis diagnosed after allogeneic hematopoietic stemcell transplantation

For recipients of allogeneic hematopoietic stem cell transplantation (HSCT), Mycobacterium tuberculosis may act as a signi¢cant opportunistic pathogen in the early posttransplantation period, especially in areas where tuberculosis (TB) is endemic. Incidence and risk factors for mycobacterial infection diagnosed in the post-HSCT period have been reviewed previously in large cohorts of patients (1^6), with factors such as matched unrelated and mismatched transplantations, treatment with total body irradiation, and graftversus- host disease (GVHD) having a signi¢cant impact onTB incidence. However, studies of TB diagnosed solely in the pediatric HSCT population are scarce, and little is known of prognostic factors after initiation of anti-TB medication. Most importantly, the severe immunosuppression that characterizes the post-HSCTperiod may have a. | 2011 John Wiley Sons A S Transplant Infectious Disease. ISSN 1398 -2273 Case report Two children with differing outcomes after treatment for pulmonary tuberculosis diagnosed after allogeneic hematopoietic stem cell transplantation . Lee . Kwon . Jang . Chung B. Cho . Jeong . Kang . children with differing outcomes after treatment for pulmonary tuberculosis diagnosed after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2011 13 520-523. All rights reserved. Abstract Tuberculosis TB is a rare infectious complication after hematopoietic stem cell transplantation HSCT but may be more significant in areas where the disease is endemic. Here we present the clinical course of 2 children with acute lymphoblastic leukemia who were diagnosed with pulmonary TB after allogeneic HSCT. Both patients were treated for either probable or possible invasive fungal infection as well as TB. One patient diagnosed withTB 3 months after HSCT showed remittent fever and symptoms that progressed to acute respiratory distress syndrome and death despite 3 modifications to the anti-TB regimen. In contrast another patient who was diagnosed with TB 8 months after transplantation responded well to anti-TB medication and completed 1 year of treatment with resolution of lung lesions. Co-morbid opportunistic infections profound host immunosuppression early after transplantation and potential risk of multi-drug resistant-TB may act as major barriers to effective treatment of TB after HSCTdespite appropriate anti-TB medication. . Lee1 H -J Kwon2 . Jang1 . Chung1 B. Cho1 . Jeong1 . Kang2 . Kim1 1Division of Hematology and Oncology Department of Pediatrics 2Division of Infectious Diseases Department of Pediatrics The Catholic University of Korea Seoul Republic of Korea Key words tuberculosis hematopoietic stem cell transplantation children Correspondence to Nak-Gyun Chung MD PhD Department of Pediatrics Seoul Saint Mary s .

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