Cytarabine
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Haemorrhagic pericardial effusion and cardiac tamponade: case report A 12-year-old boy developed haemorrhagic pericardial effusion and cardiac tamponade during treatment with cytarabine for acute myeloid leukemia [routes not stated]. The boy was resident of East Africa travelled to India to seek medical care in August 2017. He had a history of body ache and fever. He was anaemic and thrombocytopaenic. He was diagnosed with acute myeloid leukemia. His cytogenetics revealed that he had deletion of 9q. He received a three drug induction therapy with etoposide, daunorubicin, and low-dose cytarabine 100 mg/m2 twelve hourly for 10 days and achieved remission after completing the therapy. He received second cycle of induction chemotherapy as per protocol except that low-dose cytarabine was given for 8 days. He then received two cycles of consolidation with high dose cytarabine 3000 mg/m2 every 12 hourly on days 1, 3 and 5. He completed his treatment by end of January 2018, and recovered from his myelo-suppression and was discharged from the hospital. After a few days, he presented with acute onset severe breathlessness related with palpitations. Upon examination, he was found to have tachycardia, positive pulsus paradoxus, raised jugular venous pressure, and blood pressure of 90/60 mmHg. Echocardiogram results revealed massive pericardial effusion with diastolic collapse of right ventricle and atrium with dilated inferior vena cava. He had normal ventricular systolic function and normal heart stucture. Thus, a diagnosis of cardiac tamponade was made. A pericardial drain was inserted and around 500mL of haemorrhagic fluid was aspirated and pig tail was left in situ. Respiratory distress subsided following drainage of pericardial fluid. His laboratory tests including complete haemogram, coagulation profile and liver function tests were normal except a platelet count of 61. Pericardial fluid examination including biochemical testing and microbiological cultures were normal and had high number of red blood cells with absence of malignant cells. Post drainage ECG revealed no recollection and pig tail was removed by day 2. He was discharged from the hospital in a stable condition. One year post diagnosis and 6 months after the pericardial tamponade, he had normal cardiac function and was free of leukemia. Kapoor S, et al. High-dose cytarabine associated hemorrhagic pericardial effusion in a child with acute myeloid leukemia. Pediatric Hematology Oncology Journal 5: 51-53, 803502489 No. 2, Jun 2020. Available from: URL: http://doi.org/10.1016/j.phoj.2020.05.001
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Reactions 26 Sep 2020 No. 1823
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