Central Nervous System Immune Reconstitution Inflammatory Syndrome During Neutrophil Recovery in Pediatric Acute Myeloid Leukemia: A Clinical and Laboratory Observation.

BACKGROUND

Central nervous system (CNS) immune reconstitution inflammatory syndrome (IRIS) is well characterized in HIV but exceedingly rare in pediatric hematologic malignancies.

OBSERVATION: An 11.5-year-old girl with acute myeloid leukemia (AML) and probable invasive pulmonary mold infection developed an expansive right parieto-occipital lesion with a 14 mm midline shift during neutrophil recovery. Evaluation excluded leukemic infiltration and active infection. Probable CNS IRIS was diagnosed; dexamethasone with continued antifungal therapy produced rapid clinical and radiologic recovery, with sustained AML remission at 29 months.

CONCLUSIONS

CNS IRIS should be considered in pediatric AML with unexplained neurological deterioration during neutrophil recovery; timely corticosteroid therapy can be life-saving.