Multiple unusual lung etiologies in a child with acute lymphocytic leukemia.
Granulomatous lung disease is a rare and perplexing differential in pediatrics. Pulmonary Cryptococcus falls into the differential but is not high on the list, particularly in a non-AIDS patient. Methotrexate (MTX) is a commonly used agent for chemotherapy in oncology and has been documented to cause lung injury in both patients with rheumatologic and oncologic diseases. Our patient had chronic cough and then developed an opportunistic infection resulting in respiratory failure. Lung biopsy showed two underlying unusual diagnoses: MTX lung injury and cryptococcal pneumonia. His case is presented with particular attention to his prolonged road to diagnosis.
Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida.|Division of Pediatric Hematology and Oncology, Department of Pediatrics, Nemours Jacksonville, Jacksonville, Florida.
Allison
A
Bechtel
Division of Pediatric Hematology and Oncology, Department of Pediatrics, Nemours Jacksonville, Jacksonville, Florida.
Michael
M
Joyce
Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida.
Christopher J
CJ
Dudek
Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida.
John J
JJ
Sarandria
Division of Pediatric Radiology, Department of Pediatrics, Nemours Jacksonville, Jacksonville, Florida.
Chetan
C
Shah
Baptist Health/MD Anderson Cancer Center and Wolfson Children's Hospital, Jacksonville, Florida.|Department of Pathology, University of Mississippi, Jackson, Mississippi.
Ali G
AG
Saad
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002648:Child; D003453:Cryptococcosis / Q000139:chemically induced* / Q000175:diagnosis / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000382:microbiology; D008297:Male; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000175:diagnosis / Q000382:microbiology; D011014:Pneumonia / Q000139:chemically induced* / Q000175:diagnosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy*; D011379:Prognosis
Cryptococcus pneumonia; immunocompromised; leukemia; methotrexate toxicity