Reactions 1704, p37 - 2 Jun 2018 ★ S Pleural effusion due to histoplasmosis (first report for daunorubicin): case report A 23-year-old man developed pleural effusion due to histoplasmosis during treatment with daunorubicin, cyclophosphamide, vincristine and prednisolone for mixed- phenotype acute leukaemia. The man, who was hospitalised in Post Graduate Institute of Medical Education and Research in Chandigarh, India, was diagnosed with mixed-phenotype acute leukaemia. He was started on CHOP regimen, which consisted of daunorubicin, cyclophosphamide, vincristine and prednisolone [dosages and routes not stated]. He developed breathlessness and showed worsening of existing fatigue and fever following the second week of therapy. Therefore, he was rehospitalised. His chest radiograph showed right-sided moderate pleural effusion, without any gross parenchymal abnormality. Peripheral blood smears showed 42% blasts. Cytological testing of pleural fluid and blood cultures was initiated. The man was treated with vancomycin and cefoperazone/ sulbactam. His fever did not improve; therefore, amphotericin B liposomal therapy was added [liposomal amphotericin]. Therapeutic thoracentesis showed straw-colored exudative pleural fluid with pleural fluid protein to serum protein ratio of 0.89 and protein level of 3 g/L. Cytology testing was performed on 10mL haemorrhagic pleural fluid. The smears revealed many RBCs and blasts. The blasts were 2-3 times the size of mature lymphocytes, with conspicuous nucleoli, fine nuclear chromatin and moderate cytoplasm. Few blasts showed Auer rods. Additionally, many intracellular and extracellular organisms were seen. The organisms were round to ova and 2-4 microns in size, and revealed narrow-based budding, conforming to the morphologic features of Histoplasma capsulatum. These organism tested positive on Grocott–Gomori methenamine silver (GMS) staining and periodic acid-Schiff (PAS) staining. Later, he left the hospital against the advice [outcome not stated]. Author comment: "Based on our findings, we believe that physicians should cultivate a high degree of suspicion for the presence of opportunistic infections in patients with immunosuppression because delay in the recognition of histoplasmosis significantly complicates the course of illness and increases mortality." Sharma S, et al. Histoplasmosis in Pleural Effusion in a 23-Year-Old Man With Mixed-Phenotype Acute Leukemia. Laboratory Medicine 48: 249-252, No. 3, 1 Aug 2017. Available from: URL: http://doi.org/10.1093/labmed/lmx021 - India 803322732 » Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of histoplasmosis associated with daunorubicin.The WHO ADR database contained one reports of histoplasmosis associated with daunorubicin. 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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