Combination of tuberculosis of the intra thoracic lymph nodes and acute lymphoblastic leukemia in a child

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Abstract

According to scientific research, malignant neoplasms in children are biomedical risk factors for the development of tuberculosis (TB). On the contrary, the occurrence of oncological disease in a child against the background of an existing tuberculous process is extremely rare. The combination of malignant neoplasm and tuberculosis creates difficulties in differential diagnosis, treatment of diseases, prevention of exacerbations and relapses. This article presents a clinical observation – the development of acute lymphoblastic leukemia (ALL) in a 6-year-old child against the background of TB of the intrathoracic lymph nodes during treatment. TB proceeded favorably despite multiple family contact in the child and resistance of Mycobacterium tuberculosis to anti-tuberculosis drugs in adult relatives of the patient. At the onset of ALL, bilateral pulmonary infiltrates and pleural effusion were observed, which were not associated with TB. Specific polychemotherapy for ALL and continued chemotherapy for TB led to the cure of two diseases. Supportive cytostatic and immunosuppressive therapy for ALL required periodic courses of anti-relapse anti-tuberculosis therapy for 5 years. After 10 years of observation, the child is healthy. Thus, the possibility of a rare in clinical practice combination of TB and ALL in children should be taken into account in the diagnosis and treatment of these diseases. During courses of immunosuppressive therapy for ALL, there is a risk of reactivation of TB. It is necessary to recommend long-term observation of such children by a phthisiatrician and an oncologist to prevent recurrence of both diseases.

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About the authors

Marina E. Lozovskaya

St. Petersburg State Pediatric Medical University

Email: lozovskaja-marina@rambler.ru

Dr. Sci. (Med.), Professor, Head of Departmet of Phthisiatry

Russian Federation, Saint Petersburg

Yulia A. Yarovaya

St. Petersburg State Pediatric Medical University

Email: julia_yarovaya@mail.ru

Cand. Sci. (Med.), Associate Professor of Department of Phthisiatry

Russian Federation, Saint Petersburg

Elena B. Vasilieva

St. Petersburg State Pediatric Medical University

Email: helenchern27@mail.ru

Cand. Sci. (Med.), Associate Professor of Department of Phthisiatry

Russian Federation, Saint Petersburg

Ludmila V. Klochkova

St. Petersburg State Pediatric Medical University

Email: lklochkova@yahoo.com

Cand. Sci. (Med.), Associate Professor, Department of Phthisiatry

Russian Federation, Saint Petersburg

Elena A. Malysheva

Children’s TB Dispensary No. 14

Email: ptd14@zdrav.spb.ru

Phthisiatrician of Pediatric Department

Russian Federation, Saint Petersburg

Olga M. Noskova

St. Petersburg City Children Infectious Diseases No. 3

Author for correspondence.
Email: dib_3@mail.ru

Head of Tuberculosis Department No. 5

Russian Federation, Saint Petersburg

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Supplementary files

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1. Fig. 1. Patient, 5 years old. Computed tomography of the chest (tuberculosis of the intrathoracic lymph nodes), 22.08.2011

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2. Fig. 2. Patient, 6 years old. Computed tomography of the chest, 04.06.2012: multiple bilateral subpleural infiltrates in the lungs, bilateral hydrothorax (а – axial projection, b – frontal projection)

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3. Fig. 3. Patient, 6 years old. Chest computed tomography 19.06.2012: the appearance of multiple bilateral foci in the upper lungs

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4. Fig. 4. Patient, 12 years old. Plain X-ray of the chest organs 16.08.2018 (6 years of observation). No pathology was revealed

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Copyright (c) 2022 Lozovskaya M.E., Yarovaya Y.A., Vasilieva E.B., Klochkova L.V., Malysheva E.A., Noskova O.M.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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