Lichun Xie1,2, Qingling Long2, Guichi Zhou2, Sixi Liu2, Fei-Qiu Wen3,4. 1. The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China. 2. Department of Hematology/Oncology, Shenzhen Children's Hospital, No. 7019 Yitian Rd, Shenzhen, Guangdong, China. 3. The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China. fwen62@163.com. 4. Department of Hematology/Oncology, Shenzhen Children's Hospital, No. 7019 Yitian Rd, Shenzhen, Guangdong, China. fwen62@163.com.
Abstract
BACKGROUND: Invasive fungal infection (IFI) is one of the most challenging complications in children undergoing acute lymphoblastic leukaemia (ALL) treatment, but acute fungal osteomyelitis (OM) is rarely encountered. CASE PRESENTATION: Here, we describe a case of Candida tropicalis osteomyelitis in a 10-year-old patient with Philadelphia chromosome (Ph)-positive ALL. He was on remission induction therapy at the time of neutropenia, and an abscess developed in his right arm. The blood and bone cultures were positive for C. tropicalis. Antibiotics and antifungals were administered. Magnetic resonance imaging of the arm revealed an intraosseous abscess, suggestive of OM. Surgical irrigation and debridement of the bone were performed immediately. The patient was effectively treated with antifungal therapy and ALL treatment. He has fully recovered into complete clinical remission but with visible sequelae on magnetic resonance imaging (MRI). He took oral posaconazole for consolidation until disappearance of the lesion shadows on MRI and received subsequent cycles of chemotherapy in parallel. CONCLUSIONS: In the successful management of Ph-positive ALL, dasatinib, a second-generation Abl-tyrosine kinase inhibitor, is crucial. The recommended treatment for Candida osteomyelitis in Ph-positive ALL patients is a fungicidal agent combined with surgery and modification chemotherapy with dasatinib. The use of combined modalities of treatment seems to be crucial in the successful management of Ph-positive ALL.
BACKGROUND:Invasive fungal infection (IFI) is one of the most challenging complications in children undergoing acute lymphoblastic leukaemia (ALL) treatment, but acute fungal osteomyelitis (OM) is rarely encountered. CASE PRESENTATION: Here, we describe a case of Candida tropicalisosteomyelitis in a 10-year-old patient with Philadelphia chromosome (Ph)-positive ALL. He was on remission induction therapy at the time of neutropenia, and an abscess developed in his right arm. The blood and bone cultures were positive for C. tropicalis. Antibiotics and antifungals were administered. Magnetic resonance imaging of the arm revealed an intraosseous abscess, suggestive of OM. Surgical irrigation and debridement of the bone were performed immediately. The patient was effectively treated with antifungal therapy and ALL treatment. He has fully recovered into complete clinical remission but with visible sequelae on magnetic resonance imaging (MRI). He took oral posaconazole for consolidation until disappearance of the lesion shadows on MRI and received subsequent cycles of chemotherapy in parallel. CONCLUSIONS: In the successful management of Ph-positive ALL, dasatinib, a second-generation Abl-tyrosine kinase inhibitor, is crucial. The recommended treatment for Candida osteomyelitis in Ph-positive ALL patients is a fungicidal agent combined with surgery and modification chemotherapy with dasatinib. The use of combined modalities of treatment seems to be crucial in the successful management of Ph-positive ALL.
Entities:
Keywords:
Candida tropicalis; Case report; Dasatinib; Immunocompromised; Osteomyelitis; Philadelphia chromosome–positive acute lymphoblastic leukaemia
Authors: Maurizio Aricò; Martin Schrappe; Stephen P Hunger; William L Carroll; Valentino Conter; Stefania Galimberti; Atsushi Manabe; Vaskar Saha; André Baruchel; Kim Vettenranta; Keizo Horibe; Yves Benoit; Rob Pieters; Gabriele Escherich; Lewis B Silverman; Ching-Hon Pui; Maria Grazia Valsecchi Journal: J Clin Oncol Date: 2010-09-27 Impact factor: 44.544
Authors: H Inaba; D Pei; J Wolf; S C Howard; R T Hayden; M Go; O Varechtchouk; T Hahn; J Buaboonnam; M L Metzger; J E Rubnitz; R C Ribeiro; J T Sandlund; S Jeha; C Cheng; W E Evans; M V Relling; C-H Pui Journal: Ann Oncol Date: 2017-02-01 Impact factor: 32.976
Authors: K R Schultz; A Carroll; N A Heerema; W P Bowman; A Aledo; W B Slayton; H Sather; M Devidas; H W Zheng; S M Davies; P S Gaynon; M Trigg; R Rutledge; D Jorstad; N Winick; M J Borowitz; S P Hunger; W L Carroll; B Camitta Journal: Leukemia Date: 2014-01-20 Impact factor: 11.528
Authors: Stacie S Wang; Rishi S Kotecha; Anne Bernard; Christopher C Blyth; Brendan J McMullan; Megan P Cann; Daniel K Yeoh; Adam W Bartlett; Anne L Ryan; Andrew S Moore; Penelope A Bryant; Julia Clark; Gabrielle M Haeusler Journal: Pediatr Blood Cancer Date: 2019-07-16 Impact factor: 3.167
Authors: Kirk R Schultz; W Paul Bowman; Alexander Aledo; William B Slayton; Harland Sather; Meenakshi Devidas; Chenguang Wang; Stella M Davies; Paul S Gaynon; Michael Trigg; Robert Rutledge; Laura Burden; Dean Jorstad; Andrew Carroll; Nyla A Heerema; Naomi Winick; Michael J Borowitz; Stephen P Hunger; William L Carroll; Bruce Camitta Journal: J Clin Oncol Date: 2009-10-05 Impact factor: 44.544