Pleural effusion during acute myeloid leukemia induction chemotherapy: A perplexing case

Abstract

We are reporting a case of pneumonia associated with pleural effusion during the neutropenic phase of induction chemotherapy. In spite of being Adenosine deaminase negative, the pleural effusion responded only to empiric therapy with antitubercular agents. The diagnosis was confirmed with positive PCR testing for mycobacterium tuberculosis.

Covid-19 Pandemic and the Hidden Front Line

“…1,2,3 But in high-risk populations like India these cannot be used as exclusion criteria as low ADA levels are observed in about 7% of tuberculous pleural effusions. 4 This is the reason why we had quoted that low ADA in our report as inconclusive.…”

“…2 Indeed, two examples of the occurrence of normal ADA (<40 U/l) in tuberculous pleural effusions (TPE) were from patients who did not have a predominance of lymphocytes in the pleural effusion but, instead, either had a predominance of polymorphs 3 or a predominance of mesothelial cells in the pleural effusion. 4 In one of the two patients the TPE was initially left-sided, and characterised by lymphocyte predominance in association with an ADA concentration of 64 U/l. Subsequently, the patient developed a right-sided exudative pleural effusion with a neutrophil predominance and an ADA concentration of only 21 U/l.…”

“…In spite of an effusion which tested positive for Mycobacterium tuberculosis on polymerase chain reaction, evaluation of the pleural uid ADA concentration amounted to <8 U/l. 4 A more complicated relationship between ADA concentration and lymphocyte content of TPE seems to emerge from the study by Kim et al 5 In the latter study, there were 16 TPE cases in whom the pleural effusion initially had a predominance of neutrophils. In that subgroup three of the patients had an initial ADA level of <40 U/l.…”

“…We are seeing glimmers of hope of a return to some normality but as junior doctors working in palliative care we feel that we are just beginning to catch our breath and re ect on the trauma of the last few months on this … our hidden front line. 4 Beatrix Lovell-Viggers…”

Clinical efficacy of cytarabine + aclarubicin + recombinant human granulocyte colony-stimulating factor regimen combined with decitabine for adult acute myeloid leukemia

“…Most leukemia cells exhibit unique manifestations such as antigenic deletion and excessive expression, which contribute to the diagnosis of leukemia and its differentiation from other types of leukemia (Sayad et al 2017). Clinically, initial induction chemotherapy is considered for bone marrow remission, but it may sometimes fail or leukemia may recur during treatment in some patients because they are primarily drug resistant (Nair et al 2013).…”