Abstract
Patients receiving immunosuppressive therapy are at increased risk for pneumocystis carinii pneumonitis (PCP). However, recurrence of PCP is seldom documented. This report concerns recurrence of PCP in 2 patients with acute lymphoblastic leukemia (ALL) in continuous remission on maintenance therapy. An 8-year old girl, now 5 years post diagnosis, developed pneumonia on 6 occasions beginning 16 months post diagnosis. Lung biopsies x2 were diagnostic of PCP. A 14-year old girl developed 2 episodes of PCP, proven by open lung biopsy, at 19 and 36 months following diagnosis. One year later, she relapsed and died. Post mortem examination failed to show evidence of PCP. In both cases, PCP recurred despite adequate therapy of each episode and complete radiological clearing of the lungs. In the 8-year old, pulmonary function tests showed a decrease in all volume components, suggestive of a restrictive pattern without obstruction, presumably a sequelae of recurrent pneumonitis. On daily prophylaxis she remains disease-free. With combination chemotherapy and irradiation, many patients survive for extended periods of time. In children with ALL in continuous remission, PCP is a major cause of death due to infection(16-35% in various studies). Recurrent pneumonitis in immunosuppressed patients should raise a high index of suspicion of PCP, which, if identified following lung biopsy, should be treated and followed with continuous prophylaxis.
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Tebbi, K., Gross, S. 668 RECURRENCE OF PNEUMOCYSTIS CARINII PNEUMONIA IN PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA. Pediatr Res 12 (Suppl 4), 475 (1978). https://doi.org/10.1203/00006450-197804001-00673
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DOI: https://doi.org/10.1203/00006450-197804001-00673