Central Nervous System Immune Reconstitution Inflammatory Syndrome During Neutrophil Recovery in Pediatric Acute Myeloid Leukemia: A Clinical and Laboratory Observation.
Adnan Deniz, Sevgi Tale, Gökçe Cırdı et al.
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Case in brief
An 11.5-year-old girl with acute myeloid leukemia and probable invasive pulmonary mold infection developed neurological deterioration during neutrophil recovery. Imaging showed an expansive right parieto-occipital lesion with a 14 mm midline shift. Evaluation excluded leukemic infiltration and active infection, leading to a diagnosis of probable central nervous system immune reconstitution inflammatory syndrome. Dexamethasone was given while antifungal therapy continued, followed by rapid clinical and radiologic recovery. AML remission was sustained at 29 months.
What made this case unusual
The case describes probable CNS IRIS during neutrophil recovery in a child with AML, a setting in which the report notes this syndrome is exceedingly rare.
Diagnostic / clinical pearl
In pediatric AML, unexplained neurological deterioration during neutrophil recovery should prompt consideration of CNS IRIS after evaluating for leukemic infiltration and active infection.
Why it matters
The report highlights that timely corticosteroid therapy may be life-saving in this presentation.