Departments of Pediatrics, Naval Medical Center, San Diego, San Diego, California, USA.
Pediatrics. 2013 May;131(5):e1639-42. doi: 10.1542/peds.2012-1126. Epub 2013 Apr 15.
A 7-year-old boy with a history of recurrent acute lymphoblastic leukemia (ALL), in remission, presented to primary care clinic after 2 days of progressive right hip pain with weight-bearing activities. He was otherwise asymptomatic at the time of presentation. Blood cultures revealed Gram-negative diplococci, which prompted an MRI that was significant for a hip joint effusion and femoral head bone marrow edema. The patient had no sick contacts and no significant past medical history other than ALL. The patient had been given all recommended childhood vaccinations. Arthrocentesis and needle biopsy of the femoral neck were not diagnostic for malignancy and revealed only mild hip joint inflammation, leading to a diagnosis of osteomyelitis. The organism in the original blood culture was identified as Haemophilus influenzae type b, β-lactamase negative. Review of the patient's medical records showed a history of complete immunization to Haemophilus influenzae type b. An immunologic evaluation was made to determine if the patient retained immunity from his other vaccinations. Pathogen-specific antibody testing revealed detectable antibodies to polio but not measles, mumps, rubella, varicella-zoster virus, tetanus, diphtheria, pertussis, or hepatitis B. This loss of immunologic memory appears to be a rarely described side effect of ALL chemotherapy. There is currently no protocol to evaluate the immunologic memory of patients who underwent chemotherapy for ALL or to revaccinate them after their treatment. It is unclear whether the loss of immunologic memory is genuinely rare or is underdiagnosed because affected patients are protected by herd immunity.
一名 7 岁男孩，曾患有复发性急性淋巴细胞白血病（ALL），现已缓解，在出现进行性右髋疼痛伴负重活动后 2 天就诊于初级保健诊所。当时他没有其他症状。血培养显示革兰阴性双球菌，促使进行 MRI 检查，结果显示髋关节积液和股骨头骨髓水肿。患者没有接触过患病者，也没有其他重要的既往病史，除 ALL 外。患者已接种所有推荐的儿童疫苗。髋关节穿刺和股骨颈针活检对恶性肿瘤无诊断意义，仅显示轻度髋关节炎症，导致骨髓炎的诊断。原始血培养中的病原体被鉴定为乙型流感嗜血杆菌，β-内酰胺酶阴性。回顾患者的病历显示，他曾完全接种过乙型流感嗜血杆菌疫苗。进行免疫评估以确定患者是否保留了其他疫苗的免疫力。病原体特异性抗体检测显示对脊髓灰质炎有可检测的抗体，但对麻疹、腮腺炎、风疹、水痘带状疱疹病毒、破伤风、白喉、百日咳或乙型肝炎没有抗体。这种免疫记忆丧失似乎是 ALL 化疗罕见描述的副作用。目前尚无评估接受 ALL 化疗的患者免疫记忆或在治疗后对其进行重新接种的方案。尚不清楚免疫记忆丧失是否真的很少见，还是因为受影响的患者受到群体免疫的保护而被漏诊。
