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de la Mata Navazo S, Slöcker Barrio M, García-Morín M, Beléndez C, Escobar Fernández L, Rincón-López EM, Aguilera Alonso D, Guinea J, Marín M, Butragueño-Laiseca L, López-Herce Cid J. Case Report: Severe ARDS in a Pediatric Hematopoietic Stem-Cell Transplantation Recipient Caused by Disseminated Toxoplasmosis. Front Pediatr 2021; 9:810718. [PMID: 35155320 PMCID: PMC8826680 DOI: 10.3389/fped.2021.810718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
Toxoplasma gondii infection is a severe complication of hematopoietic stem-cell transplantation (HSCT) recipients that can remain unnoticed without a high clinical suspicion. We present the case of a 6-year-old patient with acute lymphoblastic leukemia and HSCT recipient who was admitted to the Pediatric Intensive Care Unit (PICU) on post-transplantation day +39 with fever, hypotension, severe respiratory distress and appearance of a lumbar subcutaneous node. She developed severe Acute Respiratory Distress Syndrome (ARDS) and underwent endotracheal intubation and early mechanical ventilation. Subsequently, she required prone ventilation, inhaled nitric oxide therapy and high-frequency oscillatory ventilation (HFOV). An etiologic study was performed, being blood, urine, bronchoalveolar lavage and biopsy of the subcutaneous node positive for Toxoplasma gondii by Polymerase Chain Reaction (PCR). Diagnosis of disseminated toxoplasmosis was established and treatment with pyrimethamine, sulfadiazine and folinic acid started. The patient showed clinical improvement, allowing weaning of mechanical ventilation and transfer to the hospitalization ward after 40 days in the PICU. It is important to consider toxoplasmosis infection in immunocompromised patients with sepsis and, in cases of severe respiratory distress, early mechanical ventilation should be started using the open lung approach. In Toxoplasma IgG positive patients, close monitoring and appropriate anti-infectious prophylaxis is needed after HSCT.
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Affiliation(s)
- Sara de la Mata Navazo
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Research Network on Maternal and Child Health and Development (RedSAMID), Hospital Universitario Gregorio Marañón, Madrid, Spain.,Department of Maternal and Child Public Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - María Slöcker Barrio
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Research Network on Maternal and Child Health and Development (RedSAMID), Hospital Universitario Gregorio Marañón, Madrid, Spain.,Department of Maternal and Child Public Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Marina García-Morín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Department of Maternal and Child Public Health, School of Medicine, Complutense University of Madrid, Madrid, Spain.,Pediatric Hematology and Oncology Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Beléndez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Department of Maternal and Child Public Health, School of Medicine, Complutense University of Madrid, Madrid, Spain.,Pediatric Hematology and Oncology Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laura Escobar Fernández
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elena María Rincón-López
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Department of Maternal and Child Public Health, School of Medicine, Complutense University of Madrid, Madrid, Spain.,Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David Aguilera Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Department of Maternal and Child Public Health, School of Medicine, Complutense University of Madrid, Madrid, Spain.,Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jesús Guinea
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mercedes Marín
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laura Butragueño-Laiseca
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Research Network on Maternal and Child Health and Development (RedSAMID), Hospital Universitario Gregorio Marañón, Madrid, Spain.,Department of Maternal and Child Public Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Jesús López-Herce Cid
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Research Network on Maternal and Child Health and Development (RedSAMID), Hospital Universitario Gregorio Marañón, Madrid, Spain.,Department of Maternal and Child Public Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
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