A 13-year-old boy with a history of SAA underwent a matched unrelated BMT 10 months ago. He is engrafted and has no history of GVHD. He is not receiving immunosuppressive therapy and remains on PJP prophylaxis per routine supportive care guidelines. He presents to his hematologist with a recent history of thrombocytopenia and a new-onset excruciating headache refractory to over the counter analgesia. He is admitted to the hospital for platelet transfusion and further imaging. Unfortunately, he experiences a sudden neurologic decline necessitating intubation. A brain MRI reveals numerous enhancing lesions throughout both cerebral and cerebellar hemispheres with punctate microhemorrhages and surrounding vasogenic edema. He undergoes extensive infectious disease testing of blood and cerebral spinal fluid. On lumbar puncture, he is noted to have elevated intracranial pressure (ICP) with a normal ophthalmologic exam. On expanded travel history, he is identified to have lived in China for multiple brief periods during his childhood, which assists in identifying his diagnosis. Question: What is the likely underlying infectious etiology of his MRI findings and neurologic decline? Answer: CNS Toxoplasmosis.
An 8-year-old boy, with a history of relapsed acute myeloid leukemia (AML) after an UCT, is admitted to the hospital to begin preparation for a second HCT, using a second UCB graft that will be infused in 7 days. On the third day of his myeloablative preparative chemotherapy, 4 days prior to infusion of his second transplant, he develops a temperature of 39.8°C. On examination, he is hypotensive (blood pressure is 64/32 mmHg) and tachycardic at 150 beats/min. His lungs are clear to auscultation. Blood cultures are obtained from his central line, and he is started on broad-spectrum empiric antibacterial antibiotics. He receives multiple fluid boluses and his hemodynamic status improves. Question: What is the likely underlying etiology of his hemodynamic change? Answer: Gram-positive infection of his central venous catheter.