Reactions 1704, p106 - 2 Jun 2018 Various toxicities: case report A 2-year-old girl developed adrenal insufficiency following dexamethasone withdrawal. Additionally, she developed neutropenia, thrombocytopenia and anaemia following treatment with cladribine [not all routes, dosages and indications stated]. The girl, who had a history of prematurity and postural plagiocephaly was admitted to the paediatric department with afebrile generalised tonic-clonic seizure with severe hyponatraemia. She started receiving treatment with dexamethasone. The histomorphology and immunoprofile were compatible with a juvenile xanthogranuloma (JXG). Three weeks after the surgery, she developed adrenal insufficiency secondary to the dexamethasone withdrawal. One month after the surgery, an MRI was performed, which showed tumour growth with radiologically aggressive characteristics. Three months after the diagnosis of JXG, she started receiving treatment with cladribine as a second line of therapy. She received 8 cycles of IV cladribine in a daily two-hour infusion for 5 days every 3 weeks. Initially, she received cladribine 0.2 mg/kg/day, then it was increased to 0.3 mg/kg/day. She did not develop any toxicity till cycle 2. However, in the next three cycles, she developed grade 1 thrombocytopenia and grade 2 th neutropenia. After the 6 course, she developed grade 1 anaemia, grade 2 thrombocytopenia and grade 3 neutropenia [durations of treatments to reactions onsets not stated]. Subsequently, the girl’s cladribine dose was reduced to 0.2 mg/Kg/day. A repeat PET-MRI showed remarkable response with cladribine. Subsequent imaging also consistent with a good clinical response. Thereafter, she had a normal neurologic development. Her adrenal insufficiency was resolved [not all outcomes stated]. Author comment: "The patient’s clinical situation three weeks after surgery was the following: . . . adrenal insufficiency secondary to withdrawal of dexamethasone". "Our patient had a grade 3 hematological toxicity with no serious infectious events, maintaining mild thrombocytopenia during the first six months following end of [cladribine] treatment, which has currently been resolved." Areal-Hidalgo P, et al. Isolated intra-axial central nervous system juvenile xanthogranuloma (JXG). Clinical management and follow-up with PET-MRI. Pediatric Hematology Oncology Journal 3: 24-28, No. 1, Mar 2018. Available from: URL: http://doi.org/10.1016/j.phoj.2017.12.003 - Spain 803323729 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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