Septic shock and acute respiratory distress syndrome in Ph-positive acute lymphoblastic leukemia treated with imatinib-containing chemotherapy: A case report

Abstract

Despite the improved outcome of Ph-positive acute lymphoblastic leukemia (Ph+ ALL) with tyrosine kinase inhibitors in children, side effects and complications of treatment are still major concerns. In this report, we describe the case of a 13-year-old boy who was diagnosed as having Ph+ ALL and treated with chemotherapy including imatinib. He developed febrile neutropenia on day 14 after the re-induction therapy. An antibiotic agent was immediately administered to the patient, but septic shock and, following acute renal failure, intestinal edema and acute respiratory distress syndrome progressed. He died on day 62. Autopsy findings showed that the cause of death was multiple organ failure from septic shock. E. coli was detected in his blood culture. The mechanism of sepsis was considered as a bacterial translocation from his intestine. These findings show that the immediate use of antibiotics in the case of prolonged febrile neutropenia is recommended, because bacterial translocation will be induced by the imatinib-containing chemotherapy in Ph+ ALL patients.