Severe Veno-Occlusive Disease in a Child With Wilms Tumor: Acute Management and Subsequent Bridging With Irinotecan Treatment.
Jessica Chumsky, Mahvish Rahim, Rachel Offenbacher et al.
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Case in brief
A pediatric patient with Wilms tumor developed severe hepatic veno-occlusive disease (VOD) following treatment with dactinomycin and vincristine. Acute management involved the use of a molecular adsorbent recirculating system (MARS) to address liver failure. The patient was subsequently treated with irinotecan and vincristine as a bridging chemotherapy, allowing for the safe reintroduction of dactinomycin. The patient remains in remission without long-term complications from VOD.
Diagnostic / clinical pearl
Clinicians should consider the risk of hepatic veno-occlusive disease in pediatric patients undergoing chemotherapy, particularly with agents like dactinomycin and vincristine.
Why it matters
This case highlights the potential for MARS in managing acute liver failure due to VOD and the use of low-hepatotoxic bridging regimens to maintain disease control.