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Fatal cryptococcosis presenting as hepatobiliary dysfunction in an ALL patient

Article type: Research Article

Authors: McNew, Brandon R. | El-Sheikh, Ayman | Kirby, Patricia A. | Bishop, Warren P. | Abusin, Ghada A.

Affiliations: Department of Pediatrics, Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA | Department of Pathology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA | Department of Pediatrics, Division of Pediatric Gastroenterology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

Note: [] Correspondence: Brandon McNew, MD, 200 Hawkins Drive- 2518 JCP, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. Tel.: +1 319 353 7110; Fax: +1 319 356 7659; E-mail: brandon-mcnew@uiowa.edu

Keywords: Cryptococcus neoformans, pediatric, acute lymphoblastic leukemia, hepatobiliary dysfunction, Down syndrome

DOI: 10.3233/JPI-140416

Journal: Journal of Pediatric Infectious Diseases, vol. 9, no. 2, pp. 101-107, 2014

Received 11 February 2014
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Accepted 11 April 2014
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Published: 2014
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Abstract

Although current therapies for acute lymphoblastic leukemia (ALL) in children provide high cure rates, invasive fungal infections remain a significant source of mortality. We report a fatal case of cryptococcosis presenting as hepatic dysfunction in a patient with ALL and Down syndrome. Autopsy results confirmed Cryptococcus septicemia with involvement of lungs, liver, and lymph nodes. The severity of the fungal sepsis and underlying immunosuppression probably contributed to the unusual presentation and fatal outcome. This report highlights the need to consider cryptococcal infection as a cause of sepsis syndrome in immunocompromised patients when bacterial cultures are negative.

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