COVID-19 in a Leukemic Child

The newly emerged SARS-CoV-2 Betacoronavirus strain has infected more than one million people worldwide. The COVID-19 infection in children was reported to be less severe compared to adults. At this point, there were limited data available to describe the effect of COVID-19 infection in immunocompromised children. We reported a case of SARS-CoV-2 infection in an immunocompromised child with a delayed virus clearance. The report signifies the variability in the severity of SARS-CoV-2 infection in immunocompromised children together with a prolonged period of viral clearance.

Generalized exfoliative skin rash as an early predictor of supratherapeutic voriconazole trough levels in a leukemic child: A case report

Background and Purpose: Skin rashes, mostly seen in children and adolescents, are considered among the most common side effects of azole antifungals. Although therapeutic concentrations of voriconazole (VCZ) have been documented for infected skin, there is no evidence specifying whether specific dermatologic side effects could predict high VCZ serum concentration, especially in high-risk leukemic children.Case report: Herein, we report a unique skin side effect of VCZ in a 5-year-old boy with T-cell acute lymphoblastic leukemia (ALL) referred to Amir Medical Oncology Center in Shiraz, Iran. The patient experienced erythroderma and macular rashes shortly after VCZ consumption, leading to generalized exfoliative skin rashes. Concurrent to these skin manifestations, VCZ serum concentration reached the supratherapeutic levels despite the recommended VCZ doses. As a result, VCZ was withheld, and the patient was treated with caspofungin. The lesions were resolved gradually within 2 weeks, and the patient successfully completed his treatment course with caspofungin. Conclusion: The unique case presented in this study emphasizes the need for a high index of suspicion for VCZ toxicity in any patient with atypical dermatologic manifestations, especially generalized exfoliative skin rashes. Based on this report, VCZ supratherapeutic concentration could be predicted early in the course of treatment. Additional therapeutic dose monitoring should be considered to establish a confirmatory diagnosis. It is required to further investigate the toxic effect of high VCZ concentration on the skin epithelium.

mcr-1.2, a NewmcrVariant Carried on a Transferable Plasmid from a Colistin-Resistant KPC Carbapenemase-Producing Klebsiella pneumoniae Strain of Sequence Type 512

ABSTRACTA novelmcrvariant, namedmcr-1.2, encoding a Gln3-to-Leu functional variant of MCR-1, was detected in a KPC-3-producing ST512Klebsiella pneumoniaeisolate collected in Italy from a surveillance rectal swab from a leukemic child. Themcr-1.2gene was carried on a transferable IncX4 plasmid whose structure was very similar to that ofmcr-1-bearing plasmids previously found inEscherichia coliandK. pneumoniaestrains from geographically distant sites (Estonia, China, and South Africa).

Recurrent rhino-ocular-cerebral mucormycosis in a leukemic child: a case report and review of pediatric literature

Mucormycosis is an uncommon but severe fungal infection, typically observed in immunocompromized patients. We report a case of acute lymphoblastic leukemia complicated by rhino-oculo-cerebral mucormycosis in a pediatric patient. Combination lipid polyeneechinocandin therapy, along with surgical debridement appeared to be effective. Nevertheless, a severe relapse occurred during posaconazole prophylaxis; antifungal therapy, hemimaxillectomy and suspension of chemotherapy were performed. Although mucormycosis is a frequently lethal infection, prompt diagnosis and aggressive treatment can be successful even in cases of relapse.