Xeroderma pigmentosum and acute myeloid leukemia: a case report

BACKGROUND

Xeroderma pigmentosum is a rare inherited disease characterized by extreme hypersensitivity to ultraviolet rays and predisposing to cutaneous malignancies that can appear in childhood. These manifestations are often associated with ocular lesions and sometimes with neurological disorders. The association of xeroderma pigmentosum with internal neoplasms such as acute myeloblastic leukemia is not reported with great frequency, which confirms the rarity of this occurrence.

CASE REPORT

A 26-year-old Moroccan women, xeroderma pigmentosum patient, was diagnosed with acute myeloblastic leukemia with a complex karyotype. Due to the adverse risk of the xeroderma pigmentosum association with acute myeloblastic leukemia and the profile of acute myeloblastic leukemia with complex karyotype and monosomy 7, which constitute factors of poor prognosis, as well as the absence of studies conceding the tolerance of the chemotherapy by patients suffering from xeroderma pigmentosum, our patient was put under low-dose cytarabine protocol with granulocyte colony-stimulating factor. Unfortunately, she died on the tenth day of chemotherapy by acute pulmonary edema of cardiogenic pace complicated by tamponade.

CONCLUSION

According to reports, it is the second case showing association of xeroderma pigmentosum with acute myeloblastic leukemia. The management of these patients remains a challenge. Studies focusing on xeroderma pigmentosum patients developing hematological malignancies are necessary to better understand the most appropriate strategies and precautions for this specific case.

Outcome of Acute Myeloid Leukemia in Children Adolescents and Young Adults Treated with an Uniform Protocol in Casablanca, Morocco

Treatment of acute myeloblastic leukemia in children, adolescents and young adults (AYA) is a challenge in low-income countries. To evaluate treatment outcomes of children (≤ 15 years) and AYA (15-30 years) diagnosed with novo AML and treated in a single center according to the AML-MA 2011 protocol. From January 2011 to December 2015, eligible patients (age ≤ 30 years) with novo AML had been enrolled on a uniform treatment protocol. The diagnosis was confirmed according to the FAB classification using the WHO 2008 criteria. Patients with WBC ≥ 50 G/L had pretreated 4 days of hydroxyurea followed by two inductions and two consolidations. Supportive care consisted of transfusion of labile blood products, antibiotics and antifungals, and patient and family education by the hygiene team. 155 patients were recruited, 41 were < 15 years old (22 boys, median age 7.8 years). Of the 114 AYA enrolled, (48 women, median age 23 years). Complete remission after two inductions was 28/41 (68.3%) of the children, including 100% of the children in the favorable group and 71/114 (62.3%) of the AYA, 22 of whom (68.7%) were in the favorable group. The number of deaths among children was 6 (14.6%). The evaluation of the AML-MA-2011 National Protocol in the age groups of children and AYA reveals that the objective of treatment is almost achieved in terms of complete remission in the two age groups.

[Disseminated fusariosis during autologous stem cells transplant]

Fusarium is a filamentous brown fungus found in soil, on plants and outdoors responsible for localized or disseminated infections. Diagnosis is based on blood cultures and skin biopsy. Disseminated fusariosis is a rare and serious fungal infection, that occurs especially in neutropenic immunosuppressed patients. Treatment is difficult and mortality is estimated between 50 and 70% in adult patients. This infection is rare in Morocco. We report a case of systemic fusariosis in patient with multiple myeloma during a second autologous stem cell transplant. At day 4 of the autologous stem cells transplant the patient had febrile neutropenia and diarrhea; he received ceftazidime, metronidazole and amikacin for 2 days. The patient still febrile was treated by imipenem and vancomycin without bacteriological proof. At day 10 the patient presented difficulty of breathing and wheezing on auscultation of the lungs, and received nebulization with salbutamol every 6 hours. The CT scan shows interstitial infiltrate of the right lung with micronodules. At day 11 he was treated by voriconazole with clinical improvement. At day 19, Fusarium sp. was identified on the Sabouraud blood culture. The patient left the transplant unit at day 25, he received 6 weeks of voriconazole with clinical and radiological improvement.