Abstract
We report a case of atypical Philadelphia chromosome (ph1) -positive acute lymphoblastic leukemia (ALL) accompanied by the development of hemolytic uremic syndrome (HUS) five months after a bone marrow transplant (BMT). The patient, a 2-year-9-month old girl, was diagnosed as having ALL at the age of 1-year and 9-months. She received bone marrow from an HLA identical, MLC-negative 5-year-old sister during her second complete remission. At 142 days post-transplant, she had a loss of appetite, pyrexia, whitish aqueous stools, blepharedema and hematuria. Her laboratory tests revealed RBC 346 × 104/μl, Hb 9.5 g/dl, reticulocytes 18% with fragmented red blood cells, LDH 513 IU/l, BUN 28.1 mg/dl and haptoglobin 10 mg/dl. A urinalysis revealed protein and occult blood. Based on the data, HUS was diagnosed. A stool sample tested positive for rotavirus antigen. E. coli was not cultured in the stool however, VT antibody was detected in the serum. We strongly believe the cause of HUS in this case was infection with a mixture of rotavirus and E. coll.
