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SARS-CoV-2 Infection Mimicking Neutropenic Fever during Chemotherapy for Acute Lymphoblastic Leukemia: A Case Report

Clinical Pediatric Hematology-Oncology.2023;30(1):47-51. doi:10.15264/cpho.2023.30.1.47

Children with SARS-CoV-2 infection typically exhibit mild respiratory symptoms, with only a small proportion presenting with gastrointestinal symptoms. However, children and adolescents with cancer may develop severe illnesses when infected with respiratory viruses. Most patients are asymptomatic or have mild-to-moderate infections, but a significant percentage face severe or critical COVID-19-related illnesses. Diagnosing SARS-CoV-2 in pediatric patients is challenging because of frequent asymptomatic cases or those presenting with only a fever. In pediatric patients with SARS-CoV-2, heightened inflammatory markers and coagulation abnormalities are common. Increased levels of inflammatory markers and lymphopenia are risk factors for severe illness, making essential blood tests crucial as potential indicators of disease severity. Febrile neutropenia (FN), a common and potentially fatal side effect of chemotherapy, occurs in roughly 50% of children receiving cancer chemotherapy, and individuals with FN should remain vigilant for SARS-CoV-2 infection, even with mild symptoms. COVID-19-related fatalities occur in 4% of pediatric patients, which is significantly lower than the 25% observed in adult cancer patients but disproportionately higher than the 0.5% mortality rate among general pediatric cohorts.The case of a 12-year-old boy with neutropenic fever undergoing intensive anticancer therapy who was later confirmed to have SARS-CoV-2 infection highlights the importance of vigilance in such patients.

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Beta-Thalassemia with Initial Presentation as Immune Thrombocytopenia:A Case Report

Hyun Sik KANG

Clinical Pediatric Hematology-Oncology.2023;30(1):42-46. doi:10.15264/cpho.2023.30.1.42

Immune thrombocytopenia (ITP) is characterized by a low platelet count caused by immune-mediated platelet destruction. In children, ITP usually resolves on its own within three months, but treatment may be necessary in some cases. Beta-thalassemia (BT) is an inherited anemia caused by a deficiency in beta-globin protein chain synthesis, and its prevalence is increasing worldwide. Anemia is the most critical symptom, and its severity varies from mild to severe. Patients with BT typically have normal white blood cell (WBC) and platelet counts; however, in some cases, they may experience thrombocytosis or thromboembolic events. Thrombocytopenia is rare in patients with BT; however, some cases of ITP and BT co-occurrence have been reported in patients with thrombotic thrombocytopenic purpura (TTP). This report describes the case of a five-year-old girl diagnosed with BT who presented with immune thrombocytopenia and received rituximab.

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Long-Term Anticoagulation Therapy for Antiphospholipid Syndrome Following Unsuccessful Arterial Thrombosis Stent Procedure: A Case Report

Hyun Sik KANG

Clinical Pediatric Hematology-Oncology.2023;30(1):36-41. doi:10.15264/cpho.2023.30.1.36

Antiphospholipid syndrome (APS) is an autoimmune, multisystemic disorder marked by arterial, venous, or small-vessel thromboembolic events and persistence of antiphospholipid antibodies (aPL). Approximately 50% of APS patients exhibit primary disease features, while the remainder present with concurrent systemic autoimmune conditions. Venous thromboses are more common than arterial thromboses, with the latter primarily developing within the cerebral arteries, as in transient ischemic attacks or strokes. The incidence of thrombosis is higher in cases of APS with systemic lupus erythematosus than in primary APS. Thrombocytopenia, observed in 20-40% of APS patients, is generally moderate, asymptomatic, and does not require intervention. Thrombosis may be linked to autoimmune hemolysis, both of which are associated with aPL. Triple positivity, a high-risk serological profile, including lupus erythematosus, anti-cardiolipin antibodies, and anti-B2 glycoprotein I antibodies, is related to aPL. Positive results for all three serologic tests significantly increase thrombosis risk, necessitating continuous aspirin and warfarin use to mitigate risk.We here report a case involving a 15-year-old girl with triple-positive APS who underwent unsuccessful thrombolysis and balloon catheter dilation procedures and required long-term arterial thrombosis treatment with aspirin and warfarin.

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Thrombotic Thrombocytopenic Purpura as the First Symptom of Systemic Lupus Erythematosus: A Case Report with Review of Literature

Young Min JO ; Cheol Hwan SO ; Du Young CHOI

Clinical Pediatric Hematology-Oncology.2023;30(1):30-35. doi:10.15264/cpho.2023.30.1.30

Thrombotic thrombocytopenic purpura (TTP) can cause serious morbidity and mortality, and differentiating between this disease and systemic lupus erythematosus (SLE) can prove challenging. Although rare, TTP accompanied by SLE is linked to several complications and a higher mortality rate. Herein, we report a case of a 16-year-old boy who presented with systemic symptoms, such as petechiae, and was diagnosed with acquired TTP following a laboratory test. Steroid treatment was initiated and a diagnosis of SLE was reached after the symptoms had improved. Treatment with low-dose prednisone in addition to hydroxychloroquine was continued. The patient did not develop renal failure or neurologic deficit. No specific symptoms were observed after treatment and during the follow-up period. Early treatment of SLE is crucial, but it is difficult to reach an early diagnosis because the symptoms are similar to those of TTP. In the current study, an early diagnosis of TTP led to prompt treatment, thereby avoiding the fatal symptoms that could be caused by SLE.

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Large Hepatocellular Adenoma Presenting with Iron Deficiency Anemia: A Case Report

Young Kwon KOH ; Su Hyun YOON ; Sung Han KANG ; Hyery KIM ; Ho Joon IM ; Suhyeon HA ; Jung-Man NAMGOONG ; Kyung-Nam KOH

Clinical Pediatric Hematology-Oncology.2023;30(1):25-29. doi:10.15264/cpho.2023.30.1.25

Hepatocellular adenoma is an uncommon, benign liver tumor usually occurring in patients using estrogen or anabolic androgens and in those with a genetic disease, including glycogen storage disease. Hepatocellular adenomas can sometimes induce pain. However, it is usually asymptomatic. Moreover, few studies have reported cases of hepatocellular adenomas presenting with iron deficiency anemia. Herein, we report a pediatric case of a large hepatocellular adenoma, presenting with iron therapy-refractory iron deficiency anemia. A 14-year-old boy was diagnosed with hepatocellular adenoma during an anemia work-up. Improvement in iron deficiency anemia was observed after tumor resection.

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Intralobar Nephroblastomatosis Mimicking Wilms Tumor Treated with Chemotherapy after Removal of the Affected Kidney

Hirozumi SANO ; Ryoji KOBAYASHI ; Satoru MATSUSHIMA ; Daiki HORI ; Masato YANAGI ; Daisuke SUZUKI ; Go OHBA ; Hiroshi YAMAMOTO ; Kunihiko KOBAYASHI

Clinical Pediatric Hematology-Oncology.2023;30(1):21-24. doi:10.15264/cpho.2023.30.1.21

Nephroblastomatosis (NBM) is a precursor of Wilms tumor. We herein report a case in which Wilms tumor was initially suspected and the affected kidney was removed.The tumor was subsequently diagnosed as intralobar NBM and a favorable outcome was achieved with postoperative chemotherapy. A 2-year-old boy who presented with gross hematuria was found to have an enlarged left kidney with hydronephrosis.Needle biopsy of the left kidney suggested Wilms tumor and left nephrectomy was performed. The tumor was histopathologically diagnosed as intralobar NBM.Although NBM is regarded as a precancerous lesion, a definite treatment plan has not yet been established. In the present case, we used a similar chemotherapy regimen to that for Wilms tumor. Eight years after the completion of chemotherapy, Wilms tumor has not developed or recurred. Appropriate management plans need to be developed by accumulating similar cases.

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Acute Complications of Pediatric Allogeneic Hematopoietic Stem Cell Transplantation and Their Effects on Survival: A Single-Center Experience in Korea

Kyoung Min LEE ; Won Ki AHN ; Jung Woo HAN ; Chuhl Joo LYU ; Seung Min HAHN

Clinical Pediatric Hematology-Oncology.2023;30(1):11-20. doi:10.15264/cpho.2023.30.1.11

Background: Acute complications within 100 days after allogeneic hematopoietic stem cell transplantation (HSCT) can increase immediate mortality as well as the risk of chronic complications and morbidity. A comprehensive review collecting systemic complications following transplantation would be important in pediatric patients. Methods: We report a retrospective study of pediatric patients who underwent allogeneic HSCT during the 11 years (2009-2020), and their acute complications after transplantation within 100 days. A total 227 pediatric patients’ (90 females, 137 males) data were collected. Results: Among the patients, 62.6% (N=142) suffered from acute graft-versus-host disease, and 118 (52.0%) patients had an acute infection. Pulmonary complications occurred in 52 (22.9%) patients followed by hepatic sinusoidal obstruction syndrome in 30 (18.1%) patients. In the study, 19 died within the first 100 days after HSCT (8.4%), and the 5-year overall survival rate of the patients was 65.4%. Conclusion This study widens the understanding of acute toxicities of pediatric HSCT. A significant number of children still have experienced a variety of acute infectious or non-infectious complications after allogeneic HSCT that contribute to morbidity and mortality. Therefore, continuous efforts are needed to reduce them.

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Recent Advances in Diagnostic and Surveillance Strategies for Childhood Cancer Predisposition Syndromes

Jae Won YOO

Clinical Pediatric Hematology-Oncology.2023;30(1):1-10. doi:10.15264/cpho.2023.30.1.1

Cancer predisposition syndromes (CPS) are a group of genetic disorders that increase the risk of developing various types of cancer. The prevalence of CPS in children has been known to be up to 18-20% based on recent reports. However, this number may still be an underestimation. Appropriate surveillance and early detection of cancer is important for improving survival outcomes of patients with CPS, making it important for clinicians to recognize flag signs and refer patients to genetic counselling. Advances in high-throughput sequencing and imaging modalities, such as wholebody MRI, have enabled personalized risk assessment and patient-tailored management of CPS. Optimizing surveillance strategies is also a focus of recent research to minimize risks associated with screening procedures, radiation exposure, and psychological burden on patients and their families. This review aims to provide the latest updates on diagnostic and surveillance strategies for childhood CPS to assist pediatricians in recognizing, referring, and managing children at risk for CPS.

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Primary Cardiac Hemangioendothelioma in an Infant: A Case Report

Jeong wook SEO ; Mi Kyoung SONG ; Sung Hye PARK ; Hye Eun PARK ; Sin Ae PARK

Clinical Pediatric Hematology-Oncology.2019;26(1):60-65. doi:10.15264/cpho.2019.26.1.60

Primary cardiac tumors are rare, with a prevalence of 0.001–0.2%. Among such tumors, cardiac hemangioendotheliomas are some of the most uncommon. In Korea, there have been no reports of hemangioendothelioma occurring in the heart of infants. We herein report a case of an infant that was admitted to our medical center and presented with cough and a runny nose. The initial diagnosis was acute bronchiolitis. Cardiomegaly was observed on chest radiography. Echocardiography revealed a tumor measuring 3.5×4.0 cm in the right atrium. The infant was transferred to a tertiary medical center for tumor excision. The excised lesion was 3.8×3×3.2 cm in size, and biopsy confirmed a diagnosis of hemangioendothelioma. In this case report, we describe our experience with a rare case involving cardiac tumor in an infant with an upper respiratory tract infection.
Biopsy ; Bronchiolitis ; Cardiomegaly ; Cough ; Diagnosis ; Echocardiography ; Heart ; Heart Atria ; Heart Neoplasms ; Hemangioendothelioma ; Humans ; Infant ; Korea ; Nose ; Prevalence ; Radiography ; Respiratory Tract Infections ; Thorax ; Twins

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Various Complications after a Vascular Procedure in Patients with Hemophilia

Yeon Soo HA ; Young Shil PARK

Clinical Pediatric Hematology-Oncology.2019;26(1):55-59. doi:10.15264/cpho.2019.26.1.55

Hemophilia, an inherited bleeding disorder, is caused by a deficiency of coagulation factor VIII or IX. Most of patients with hemophilia need vascular procedure, which can lead to complications. Even though these complications can also occur in normal people, hemophilia and coagulopathy are particular risk factors. We reviewed medical records of patients with hemophilia who underwent vascular procedures and investigated its complications. Vessel-related complications occurred in five patients. Three patients had pseudoaneurysms after radial arterial puncture. All patients underwent coagulation factor replacement or ultrasound-guided compression and showed improvement. Neuropathy developed in one patient due to a hematoma that occurred after blood sampling. The hematoma improved, but motor and sensory deficits remained and neuropathy was confirmed. One patient died of uncontrolled bleeding after angiography. Vascular procedures require more attention in patients with hemophilia. Caution and prevention of complications is essential, even before the patient is diagnosed with hemophilia.
Aneurysm, False ; Angiography ; Blood Coagulation Factors ; Factor VIII ; Hematoma ; Hemophilia A ; Hemorrhage ; Humans ; Medical Records ; Punctures ; Risk Factors

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