Spontaneous Remission Of Acute Lymphoblastic Leukemia Following Candida Tropicalis Fungemia
McCormick, B. J., & Imran, H. (2024). Spontaneous Remission of Acute Lymphoblastic Leukemia Following Candida tropicalis Fungemia. Cureus, 16(6), e62435. https://doi.org/10.7759/cureus.62435
View Original Source →Abstract
Spontaneous remission (SR) in acute lymphoblastic leukemia (ALL) is a poorly understood phenomenon that has been sporadically reported in medical literature for over a century, and the molecular and immunologic mechanisms of remission pose interesting clinical questions. Furthermore, the often-transient nature of these remissions poses a challenge to physicians in formulating an approach to treatment. We report on a rare case of Candida tropicalis sepsis in a three-year-old female with high-risk ALL who received less than two months of treatment prior to sepsis and subsequent SR.
Case Details
Disease Location
Bone marrow
Personal Characteristics
3-year-old caucasian female
Clinical Characteristics
Five-day history of subjective fever, oral stomatitis, unilateral leg pain, and pain in the vaginal area. On the day of admission, she experienced a bout of severe hematemesis. On initial exam, she exhibited hepatomegaly and mild cervical lymphadenopathy, and the working diagnosis was a bacterial infection for which she started amoxicillin. Radiography of the painful leg revealed suspicious lesions. Admission labs revealed pancytopenia. A peripheral blood smear revealed 9% blasts. Bone marrow studies revealed 39% phenotypically abnormal b-precursor cells she was diagnosed with standard-risk b-precursor acute lymphoblastic leukemia (all) and began induction therapy with intravenous cytarabine, vincristine, dexamethasone, pegaspargase, and intrathecal methotrexate. 30 days of induction therapy, a repeat bone marrow biopsy revealed persistent disease with 1.5% blasts on flow cytometry. She was started on consolidation therapy with cyclophosphamide, cytarabine, mercaptopurine, intrathecal methotrexate, vincristine, and pegaspargase. During the last week of consolidation therapy, she was admitted to the intensive care unit for septic shock with acute respiratory distress syndrome (ards), and she was found to have candida tropicalis fungemia.
Remission Characteristics
On day 63 of hospitalization, a bone marrow examination demonstrated no residual disease on flow cytometry
Treatment & Mechanisms
Proposed Remission Mechanisms
Sepsis triggers the release of cytokines that up-regulate lymphocyte surveillance and destruction of cancer cells. B-cells and t-cells may recognize blasts, or antibodies formed against infectious agents, which may cross-react with antigens on leukemic blasts leading to sr
Clinical Treatment
Bone marrow aspiration intravenous cytarabine, vincristine, dexamethasone, pegaspargase, and intrathecal methotrexate. Cyclophosphamide, mercaptopurine, vincristine.
Non-Clinical Treatment
None reported