Abstract
A seven-year-old boy with diffuse T cell lymphoblastic lymphoma was treated with combination chemotherapy (predonisolone 60 mg/m2, vincristine 1.5 mg/m2, l-asparaginase 6, 000 U/m2, pirarubicin 20 mg/m2, cyclophosphamide 1, 200 mg/m2) and he was in a complete remission state after 16 weeks. However, during the consolidation phase 21 weeks post induction therapy the patient developed a fever and signs of acute respiratory distress. A presumptive clinical diagnosis of cytomegalovirus (CMV) pneumonia was made and treatment with ganciclovir 10 mg/kg and high dose methylprednisolone 20 mg/kg were initiated. Intravenous high-titer anti-CMV immunoglobulin was added after onset of pneumonia. The patient failed to improve and therapy with amphotericin-B and fluconazole were added. After 29 days, despite intensive anti-CMV and antifungal therapy the patient died. Autopsy findings revealed culture-positive CMV interstitial pneumonia and systemic aspergillus infection of the lungs, brain and kidneys. This case emphasizes the importance of careful monitoring for the first signs of opportunistic viral and fungal infection which can be fatal in the immunocompromised patient.
