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.
A 13-year-old girl with a history of relapsed acute lymphoblastic leukemia (ALL) underwent an UCT 6 months ago. She is engrafted without evidence of GVHD and is no longer receiving immunosuppression. She presents to the emergency department with a fever of 40.1°C and tachypnea. Her saturations are 88% while breathing room air so she is placed on low flow oxygen via nasal cannula. On examination, she is in obvious distress with increased work of breathing and decreased breath sounds in the left lower lung base with rhonchi. A chest radiograph is obtained which shows a large opacity in the left lower lung field with air-bronchograms and trace pleural effusion. Question: What vaccine-preventable infection should be considered? Answer:\nStreptococcus pneumoniae.