Wang Xiaodong, Yu Uet, Li Xiaonan, Wang Chunjing, Zhang Qian, Yang Chunlan, Zhang Xiaoling, Zhang Yu, Wang Ying, Zheng Yuejie, Deng Jikui, Yang Weiguo, Liu Guosheng, Deng Guofang, Liu Sixi, Wen Feiqiu
Department of Pediatrics, First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China.
Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, Guangdong, People's Republic of China.
Infect Drug Resist. 2020 Jul 31;13:2641-2648. doi: 10.2147/IDR.S256298. eCollection 2020.
Tuberculosis is a rare but life-threatening complication in patients who received hematopoietic stem cell transplantation. Early identification and intervention are essential to prevent severe complications.
We report two pediatric patients who developed tuberculosis after receiving hematopoietic stem cell transplantation for thalassemia major among 330 recipients between January 2012 and August 2019. Patient A presented with pulmonary tuberculosis and patient B presented with lymph node tuberculosis mimicking post-transplantation lymphoproliferative disorder associated with Epstein-Barr virus reactivation. Patient B's condition was deteriorated, and shortly after the initiation of anti-tuberculosis therapy, the patient was found to have disseminated pulmonary tuberculosis. Patient B was also found to have tuberculous granulomas, an uncommon manifestation of tuberculosis causing severe airway obstruction. Both patients developed critical respiratory failure and required mechanical ventilation; however, they recovered with almost full resolution of pulmonary lesions after multiple treatment adjustments.
Tuberculosis must be carefully evaluated in all pediatric patients that receive hematopoietic stem cell transplantation, regardless of the identification of other pathogens. Prophylactic tuberculosis therapy should be considered for high-risk pediatric hematopoietic stem cell transplantation recipients from tuberculosis-endemic regions.
结核病是接受造血干细胞移植患者中一种罕见但危及生命的并发症。早期识别和干预对于预防严重并发症至关重要。
我们报告了2例在2012年1月至2019年8月期间接受造血干细胞移植治疗重型地中海贫血的330例受者中发生结核病的儿科患者。患者A表现为肺结核，患者B表现为淋巴结结核，类似与爱泼斯坦-巴尔病毒再激活相关的移植后淋巴细胞增生性疾病。患者B的病情恶化，在开始抗结核治疗后不久，发现患者患有播散性肺结核。患者B还被发现有结核性肉芽肿，这是一种导致严重气道阻塞的不常见的结核病表现。两名患者均出现严重呼吸衰竭，需要机械通气；然而，经过多次治疗调整后，他们康复，肺部病变几乎完全消退。
对于所有接受造血干细胞移植的儿科患者，无论是否鉴定出其他病原体，都必须仔细评估结核病。对于来自结核病流行地区的高危儿科造血干细胞移植受者，应考虑预防性抗结核治疗。
