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KMID : 0387820090160020139
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Clinical Pediatric Hematology-Oncology
2009 Volume.16 No. 2 p.139 ~ p.144
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A Case of Disseminated Tuberculosis in a Pediatric Patient after Matched Sibling Bone Marrow Transplantation
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Joung Jin-Kyo
Lee Kwang-Hee
Lee Jae-Wook
Yoon Jong-Seo
Lee Dong-Gun
Chung Nack-Gyun
Cho Bin
Kang Jin-Han
Lee Joon-Sung
Kim Hack-Ki
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Abstract
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Mycobacterium tuberculosis (TB) infection is seldom diagnosed after hematopoietic stem cell transplantation, but may cause significant morbidity in countries where TB is endemic. The signs and symptoms of infection usually become apparent months after engraftment, often concurrent with acute or chronic graft-versus-host disease. We report a case of rapid onset post-hematopoietic stem cell transplantation (HSCT) TB in a pediatric acute myeloblastic leukemia patient who received matched sibling bone marrow transplantation and was diagnosed with disseminated TB of the lungs and marrow within a month of transplantation. The patient was initially given a five drug anti-TB regimen that was modified three times during the course of treatment. Although follow-up acid fast bacilli (AFB) cultures became negative, the patient experienced acute sepsis, disseminated intravascular coagulation (DIC) and pulmonary hemorrhage that resulted in fatality. As methods of screening and prophylaxis are still questionable, TB should always be given due consideration as a cause of post-HSCT fever in regions where its incidence is high, regardless of time of onset of first symptoms.
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KEYWORD
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Mycobacterium tuberculosis, Pediatric bone marrow transplantation, Sepsis
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