Reactions 1097 - 15 Apr 2006

Dexamethasone/pegaspargase/vincristine

Pseudomonal infections leading to acute renalfailure in an infant: case report

A 14-month-old boy developed post-renal acute renal failuresecondary to ureteric obstruction with purulent debris fromPseudomonas aeruginosa infection after starting inductiontherapy for acute lymphoblastic leukaemia (ALL) withdexamethasone, vincristine and pegaspargase [dosages notstated].

At the time of starting chemotherapy, the boy had positiveblood cultures for P. aeruginosa and was treated withantibacterials. Ten days after starting induction therapy forALL, hypertension developed. This was thought to beassociated with corticosteroid therapy and was treated withmetoprolol and amlodipine. On day 27 of therapy, while hisleucocyte count was beginning to recover, he developedanuria.

The boy was treated with furosemide, but his urinary outputdid not improve. He also developed hyperkalaemia anduraemia, so began haemodialysis. His C-reactive protein levelwas increased to 33.2 mg/L (normal < 8). Ultrasonographyrevealed moderately echogenic, enlarged kidneys, mildbilateral dilatation of the ureters and renal pelvis, a distendedbladder containing echoic floating structures. The bladder wasirrigated. A repeat ultrasound showed increasing dilatation ofthe urinary tract. Two days later, filling defects were seenbilaterally in the ureters and renal pelvis. A post-renal cause ofacute renal failure was suspected, so cystoscopy andretrograde pyelography were performed. Purulent debris wereirrigated from the bladder and found to be positive for P.aeruginosa. He was treated with ciprofloxacin and his renalfunction normalised within 2 days.

Author comment: "[W]e hypothesize that with bonemarrow recovery at the end of induction, white blood cell"burst" contributed to the sudden obstruction of the ureterssecondary to purulent debris. The inductive therapy impairedT cell function allowing for P. aeruginosa to evade detectionand elimination. Once cell-mediated immunity was restored,a zealous response to the infectious foci was observed."Burghardt KM, et al. Pseudomonas aeruginosa infection: an uncommon cause ofpost-renal obstruction following induction therapy for acute lymphoblasticleukemia. Pediatric Blood and Cancer 46: 512-513, No. 4, Apr 2006 -Canada 801037504

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Reactions 15 Apr 2006 No. 10970114-9954/10/1097-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved