Volume 5, Issue 4 ( Journal of Clinical and Basic Research (JCBR) 2021)                   jcbr 2021, 5(4): 16-21 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

cheraghali F, shahkar L, ahaniazari A. Unilateral Pleural Effusion in a Pediatric Patient: A Case of T-Cell Acute Lymphoblastic Leukemia Complicated with COVID-19. jcbr 2021; 5 (4) :16-21
URL: http://jcbr.goums.ac.ir/article-1-331-en.html
1- Neonatal and Children Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
2- Neonatal and Children Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran , lobatshahkar@yahoo.com
3- Anesthesiology Department, Golestan University of Medical Sciences, Gorgan, Iran
Abstract:   (1839 Views)
Background: Exudative pleural effusion in children is mainly caused by bacterial infections. Here, we present a 2.5-years-old boy with acute fever, unilateral pleural effusion, and poor response to the insertion of chest tube.
Case description: The patient was admitted to the Taleghani Hospital of Gorgan (northeast of Iran) with complaint of fever starting from a week ago. The patient was treated with intravenous (IV) antibiotics and a chest tube was inserted. Considering the poor response to this treatment and leukocytosis, further assessments were made. Microbial examination of pleural fluid and SARS-CoV-2 test of nasopharyngeal swab were negative. Pleural biopsy and bone marrow aspiration analysis by flow cytometry revealed T-cell-acute lymphoid/lymphoblastic leukemia (ALL). The patient was referred to the oncology ward and chemotherapy was performed. After four weeks, he started to develop symptoms of respiratory distress, fever, and melena. The next SARS-CoV-2 test on throat swab was suspicious. Chest CT scan showed centrilobular ground glass opacity and peribronchial wall thickening in both lungs in favor of COVID-19. Treatment started with hydroxychloroquine, cotrimaxazole, meropenem, vancomycin, and pantoprazole. The patient was transferred to the PICU because of respiratory distress and decreased O2 saturation. Four days later, repeated test on nasopharyngeal swab was positive for COVID-19. Unfortunately, the patient did not respond to treatment and passed away a few days later.
Conclusion: T-cell ALL is an aggressive type of leukemia with poor response to treatment, and plural effusion is a rare presentation of malignancy in children. Our patient's condition was unfortunately complicated with COVID-19 involvement and he passed away before we see the effect of treatment on ALL.
Full-Text [PDF 187 kb]   (994 Downloads) |   |   Full-Text (HTML)  (618 Views)  
Article Type: Case report | Subject: Pediatrics

References
1. Fischer GB, Mocelin HT, Andrade CF, Sarria EE. When should parapneumonic pleural effusions be drained in children? Paediatric respiratory reviews. 2018;26:27-30. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Beaudoin S, Gonzalez AV. Evaluation of the patient with pleural effusion. CMAJ. 2018;190(10):E291-E5. [View at Publisher] [DOI] [PMID] [PMCID] [Google Scholar]
3. Yue F, Yang Z, Yang F, Liu Y, Zhao L, Chen Z, et al. Clinical observation of bronchoscopy alveolar lavage combined with thoracoscopy in the treatment of empyema in children. Medicine. 2019;98(52):e18528. [View at Publisher] [DOI] [PMID] [PMCID] [Google Scholar]
4. Liese J, Schoen C, van der Linden M, Lehmann L, Goettler D, Keller S, et al. Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010–2017: a nationwide surveillance study. Clinical Microbiology and Infection. 2019;25(7):857-64. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Meyer Sauteur PM, Burkhard A, Moehrlen U, Relly C, Kellenberger C, Ruoss K, et al. Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study. Journal of clinical medicine. 2019;8(5):698. [View at Publisher] [DOI] [PMID] [PMCID] [Google Scholar]
6. Amin M, Yousef pour S, Navidifar T. Detection of the major bacterial pathogens among children suffering from empyema in Ahvaz city, Iran. Journal of clinical laboratory analysis. 2019;33(4):e22855. [View at Publisher] [DOI] [PMID] [PMCID] [Google Scholar]
7. Adeyinka A, Kondamudi NP. Pediatric malignant pleural effusion. StatPearls [Internet]. 2021 Feb 26. [PubMed] [Google Scholar]
8. Wahla AS, Uzbeck M, El YS, Zoumot Z. malignant pleural effusion. Cleveland Clinic journal of medicine. 2019;86(2):95. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Pemmaraju N, Chang E, Daver N, Patel K, Jorgensen J, Sabloff B, et al. Extramedullary acute myeloid leukemia: leukemic pleural effusion, case report and review of the literature. Frontiers in oncology. 2014;4:130. [View at Publisher] [DOI] [PMID] [PMCID] [Google Scholar]
10. Raetz EA, Teachey DT. T-cell acute lymphoblastic leukemia. Hematology 2014, the American Society of Hematology Education Program Book. 2016 Dec 2;2016(1):580-8 [DOI] [PMID] [PMCID]
11. Sinha AA, Park G, Frazer JK. Tackling Acute Lymphoblastic Leukemia-One Fish at a Time. International journal of molecular sciences. 2019;20(21):5313. [View at Publisher] [DOI] [PMID] [PMCID] [Google Scholar]
12. Zhang H-H, Wang H-S, Qian X-W, Fan C-Q, Li J, Miao H, et al. Genetic variants and clinical significance of pediatric acute lymphoblastic leukemia. Annals of translational medicine. 2019;7(14). [View at Publisher] [DOI] [PMID] [PMCID] [Google Scholar]
13. Suharti C, Santosa SB. Malignant pleura l effusion in acute myeloid leukemia with hepatitis B viru s infection. Acta Med Indones. 2015;47(2):153-6. [View at Publisher] [Google Scholar]
14. Agarwal M, Purohit AH, Mahapatra M, Kumar R, Mishra P, Seth T, et al. Pleural Effusion as an Unusual Initial Presentation of Acute Myeloid Leukemia. Indian Journal of Hematology and Blood Transfusion. 2014;30(3):195-6. [View at Publisher] [DOI] [PMID] [PMCID] [Google Scholar]
15. Pei S-n, Kuo C-y, Ma M-c, Wang M-c. Mediastinal mass and malignant pleural effusion in an aleukemic case with pre-B acute lymphoblastic leukemia. Journal of pediatric hematology/oncology. 2009;31(2):139-41. [View at Publisher] [DOI] [PMID] [Google Scholar]
16. Parsons LN, Jarzembowski JA. Clinicopathologic analysis of malignant effusions in pediatric patients. Journal of the American Society of Cytopathology. 2017;6(2):41-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Jaime-Pérez JC, Hernández-De los Santos JA, Gómez-Almaguer D. Childhood T-cell acute lymphoblastic leukemia in a single Latin American center: impact of improved treatment scheme and support therapy on survival. Hematology, Transfusion and Cell Therapy. 2019. [View at Publisher] [DOI] [PMID] [PMCID] [Google Scholar]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Journal of Clinical and Basic Research

Designed & Developed by : Yektaweb

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0).