title: Ureteral obstruction caused by L-asparaginase-induced pancreatitis in a child with acute lymphoblastic leukemia.
abstract: L-asparaginase, an effective antileukemia and antilymphoma agent, is toxic to many organ systems. We report a case of ureteral obstruction caused by L-asparaginase via the inflammatory complication of acute pancreatitis. The patient was an 11-year-old boy with acute lymphoblastic leukemia. Six days after completing a 4-week induction therapy containing 9 doses of L-asparaginase, severe left abdominal pain developed. Abdominal computed tomography showed phlegmon formation anterior to the pancreatic head and in the left posterior pararenal space. The strands of inflammatory soft tissues encased the upper third of the left ureter, causing left hydroureter and left hydronephrosis. The ureteral obstruction resolved after insertion of a double-J catheter that remained in place for 66 days. This case suggests that L-asparaginase may play a role in the pathogenesis of ureteral obstruction in children receiving chemotherapy.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital and College of Medicine, No. 7 Chung-Shan S. Road, Taipei 100, Taiwan.
authors.forename: Chien-Han
authors.initials: CH
authors.lastname: Chen
authors.forename: Meng-Yao
authors.initials: MY
authors.lastname: Lu
authors.forename: Kai-Hsin
authors.initials: KH
authors.lastname: Lin
authors.forename: Dong-Tsamn
authors.initials: DT
authors.lastname: Lin
authors.forename: Shinn-Forng
authors.initials: SF
authors.lastname: Peng
authors.forename: Shiann-Tarng
authors.initials: ST
authors.lastname: Jou
mesh_terms: D000208:Acute Disease; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001215:Asparaginase / Q000009:adverse effects*; D002648:Child; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000139:chemically induced* / Q000150:complications; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D014517:Ureteral Obstruction / Q000209:etiology* / Q000473:pathology; D020246:Venous Thrombosis / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents; D001215:Asparaginase