Case 5: Fever and Hypoxia in a 17-year-old Boy Undergoing Cancer Chemotherapy

Abstract

1. Joana Mack, MD* 2. Amir Mian, MD* 1. *Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, AR A 17-year-old white boy with chronic myelogenous leukemia with a history of lymphoid blast crisis presents with fever and hypoxia 2 weeks after receiving vincristine, daunorubicin, and intrathecal methotrexate. He denies cough, chest pain, or difficulty breathing. He notes overall fatigue. There is no history of recent illnesses, sick contacts, or drug allergies. Home medications include scheduled nilotinib (chemotherapy), omeprazole, dapsone, and antiemetics as needed. Physical examination reveals an awake, alert, and oriented boy but cyanotic in appearance. His vital signs are stable, and pulse oximetry shows oxygen saturation of 93% on venturi mask with 50% inspired oxygen. His sclera is mildly icteric, and capillary refill is 3 seconds. His skin appears pale. Cardiac examination reveals a regular rate and rhythm, but a systolic flow murmur is auscultated. There is no increased work of breathing, and …