Effective treatment of severe forms of RSV and Pneumocystis jirovecii infections in a child with Down syndrome and acute lymphoblastic leukemia treated with chemotherapy

Abstract

There has been significant progress in acute lymphoblastic leukemia (ALL) treatment throughout the previous decades. However, infectious complications are still the main problem during cancer treatment. Literature reports show that treatment-related mortality is 2–4% and is mainly related to infection. Here, the authors report a 3-year-old patient with Down syndrome and ALL who was hospitalized in the Department of Pediatric Hematology, Oncology and Transplantology of the Medical University of Lublin. The patient was treated according to the AIEOP-BFM 2017 protocol and developed a severe co-infection of Pneumocystis jiroveci and respiratory syncytial virus during the induction phase of chemotherapy and P. jiroveci re-infection while receiving Protocol II. As a result, chemotherapy was interrupted for 51 and 31 days, respectively. The patient required the administration of broad-spectrum antibiotics, antiviral and antifungal therapy and passive oxygen therapy. Due to a severe clinical condition, the patient was also temporarily hospitalized in the Intensive Care Unit. Research revealed several risk factors for infectious complications in patients with ALL including intensive chemotherapy or Down syndrome. Therefore, despite anti-infective prophylaxis, increased medical vigilance is necessary. In the case of infectious symptoms, early diagnosis and prompt treatment should be implemented to enable the continuation of the ALL therapeutic protocol.