Xiaodong Wang1,2 ,* Uet Yu2 ,* Xiaonan Li,3 Chunjing Wang,2 Qian Zhang,2 Chunlan Yang,2 Xiaoling Zhang,2 Yu Zhang,2 Ying Wang,2 Yuejie Zheng,3 Jikui Deng,4 Weiguo Yang,5 Guosheng Liu,1 Guofang Deng,6 Sixi Liu,2 Feiqiu Wen1,2

1Department of Pediatrics, First Affiliated Hospital of Jinan University, Guangzhou, Peoples Republic of China; 2Department of Hematology and Oncology, Shenzhen Childrens Hospital, Shenzhen, Guangdong, Peoples Republic of China; 3Department of Respiratory Diseases, Shenzhen Childrens Hospital, Shenzhen, Guangdong, Peoples Republic of China; 4Department of Infectious Diseases, Shenzhen Childrens Hospital, Shenzhen, Guangdong, Peoples Republic of China; 5Pediatric Intensive Care Unit, Shenzhen Childrens Hospital, Shenzhen, Guangdong, Peoples Republic of China; 6Guangdong Key Laboratory for Emerging Infectious Diseases & Shenzhen Key Laboratory of Infection and Immunity, Shenzhen Third Peoples Hospital, Shenzhen, Guangdong, Peoples Republic of China

*These authors contributed equally to this work

Correspondence: Sixi Liu; Feiqiu Wen Email tiger647@126.com; fwen62@163.com

Background: Tuberculosis is a rare but life-threatening complication in patients who received hematopoietic stem cell transplantation. Early identification and intervention are essential to prevent severe complications. Case Presentation: We report two pediatric patients who developed tuberculosis after receiving hematopoietic stem cell transplantation for thalassemia major among 330 recipients between January 2012 and August 2019. Patient A presented with pulmonary tuberculosis and patient B presented with lymph node tuberculosis mimicking post-transplantation lymphoproliferative disorder associated with EpsteinBarr virus reactivation. Patient Bs condition was deteriorated, and shortly after the initiation of anti-tuberculosis therapy, the patient was found to have disseminated pulmonary tuberculosis. Patient B was also found to have tuberculous granulomas, an uncommon manifestation of tuberculosis causing severe airway obstruction. Both patients developed critical respiratory failure and required mechanical ventilation; however, they recovered with almost full resolution of pulmonary lesions after multiple treatment adjustments. Conclusion: Tuberculosis must be carefully evaluated in all pediatric patients that receive hematopoietic stem cell transplantation, regardless of the identification of other pathogens. Prophylactic tuberculosis therapy should be considered for high-risk pediatric hematopoietic stem cell transplantation recipients from tuberculosis-endemic regions.

Keywords: tuberculosis, hematopoietic stem cell transplantation, thalassemia, pediatric

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