title: [Mycobacterium tuberculosis infection in a pediatric patient who underwent a hematopoietic stem cell transplant].
abstract: We report the case of a 10 year old girl with a relapsed acute lymphoblastic leukemia, who underwent a haploidentical hematopoietic stem cell transplant (HSCT), with grade II skin and digestive graft versus host disease, treated with corticosteroids and cyclosporine. On day + 54, she presented fever, with no other remarkable clinical findings. Imaging study showed the presence of lung and liver nodules, liver biopsy was performed. The study included histology, staining and culture for bacteria and fungi, and the preservation of a piece of tissue at -20°C for future prospective studies. Ziehl Nielsen stain was positive, and study for Mycobacterium infection was performed. Microbiological smears of tracheal and gastric aspirate, and bronchial fluid obtained by bronchoalveolar lavage (BAL) were positive. The final report confirmed Mycobacterium tuberculosis in gastric content, sputum, BAL and liver tissue, susceptible to rifampin, isoniazid, streptomycin and ethambutol, with determination of mutations for genes rpoβ and kat G (-). Tuberculosis (TB) diagnosis was confirmed. The girl received daily therapy for two months and then she continued on three times per week therapy for 9 months. Controlled by the transplant, infectious diseases and respiratory teams, the patient remained in good general condition, with radiologic resolution of pulmonary and liver involvement and negative smears. We conclude that Mycobacterium tuberculosis infection should be part of differential diagnosis of febrile illness in patients undergoing HSCT, and biopsy should be a standard practice of early diagnosis in these patients.
authors.affiliation: Unidad de Trasplante de Médula Ósea, Hospital Luis Calvo Mackenna, Santiago, Chile. jpalmab@vtr.net
authors.forename: Julia
authors.initials: J
authors.lastname: Palma
authors.forename: Paula
authors.initials: P
authors.lastname: Catalán
authors.forename: Patricia
authors.initials: P
authors.lastname: Mardones
authors.forename: M Elena
authors.initials: ME
authors.lastname: Santolaya
mesh_terms: D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007121:Immunocompetence; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000276:immunology