Immunosuppressants
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Immunosuppressants Human coronavirus OC43 infection associated pneumonia and febrile neutropenia: case report
An 8-year-old girl developed human coronavirus OC43 (HCoV-OC43) infection associated pneumonia and febrile neutropenia during treatment with prednisolone, vincristine, epirubicin, asparaginase, methotrexate, hydrocortisone and cytarabine for B cell precursor acute lymphoblastic leukaemia (ALL) [dosages and times to reactions onsets not stated; not all routes and outcomes stated]. The girl presented with fever and an abnormal haemogram. On 24 Deecember 2019, she was diagnosed with B cell precursor ALL. Cytogenetic analysis disclosed the presence of the karyotype 46, XX, del(9)(q34),t(12;22)(p13;q11.2), while molecular analysis was negative for ETV6-RUNX1, TCF3-PBX1, and BCR-ABL1. She received chemotherapy according to the Taiwan Pediatric Oncology Group (TPOG) 2013-ALL-SR protocol comprising induction with prednisolone, vincristine, epirubicin, asparaginase [Lasparaginase]. Spinal tap and triple intrathecal therapy with methotrexate, hydrocortisone and cytarabine was performed at 7–10 days after chemotherapy. No leukemic cells were found in the cerebral spinal fluid, and on 14 January 2020, she started receiving prophylactic antibiotic and antifungal therapies with levofloxacin and micafungin, when her leukocyte count was less than 1109 cells/mL. On 20 January 2020, she developed febrile neutropenia. The girl received teicoplanin and meropenem, post collection of her blood for culture. Her blood culture yielded Streptococcus mitis, sensitive to teicoplanin. However, she gradually experienced a cough in parallel with a respiratory tract infection from her mother in the hospital. On 22 January 2020, a chest X-ray demonstrated increased infiltration in the right lower lobe. In the meantime, optical density index (ODI) of serum galactomannan was found to be 0.07. She then received azithromycin for 3 days, as atypical pneumonia resulting from a bacterial infection was speculated. Despite this, fever did not resolve, and her cough further worsened even after her leukocyte count was found to be increased on 25 January 2020. She had increased difficulty in breathing, requiring low-flow nasal cannula support. Auscultation yielded a coarse breathing sound, without wheezing or rales. A second chest X-ray revealed patchy nodular opacities in the right middle-lobe and bilateral lower-lobes. A CT scan of the chest showed multiple illdefined nodular and wedge-shape opacities, predominantly in the bilateral lower lobes. Since pulmonary fungal infection was initially suspected, amphotericin B liposomal was substituted for micafungin. Concurrently, the ODI of serum galactomannan increased to 0.15. A throat swab sample was collected and tested. A multiplex PCR-assay confirmed HCoV-OC43. One week later, bronchoalveolar lavage (BAL) fluid samples revealed the samples to be negative for fungi, acid-fast bacilli and viruses. Thus, antimicrobial agents were discontinued. Her respiratory status became asymptomatic in the follo
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