Publication

Abstract : Background Clinically evident pericardial effusion is rare in acute leukemia, although leukemia infi ltration of the pericardium is not uncommon at autopsy. We present a case of cardiac tamponade in a child with acute lymphoblastic leukemia Material and Results A 14 year-old boy presented with symptomatic anemia, low grade fever and mucocutaneous bleeding for 2 months. Examination revealed a febrile child with tachycardia, tachypnoea , cervical lymphadenopathy, and ecchymosis over extremities and hepatosplenomegaly. Blood counts revealed TLC 20X109/L with 30% blasts. Bone marrow examination and immunophenotyping was suggestive of B-lineage ALL. There was no CNS or testicular disease. Patient was started on CCG modifi ed standard BFM protocol and was a rapid early responder. He developed left subclavian vein thrombosis secondary to peripherally inserted central catheter on the same side, and was managed conservatively. On day 26 of induction patient developed diffuse pain and distension of the abdomen. Ultrasonography revealed moderate ascites with right pleural effusion. By day 28 patient deteriorated with increasing breathlessness and persistence of abdominal symptoms. Echocardiography revealed cardiac tamponade and urgent pericardiocentesis was done draining about 700 ml of hemorrhagic fl uid, a pigtail catheter was left in -situ. Fluid analysis revealed it to be exudative with 100% lymphocytes, negative for malignant cells and acid fast bacilli. Fluid Adenosine deaminase levels were elevated. Patient was in hematological remission. He was started on antitubercular therapy by day 29 and showed a dramatic response over the next few days, the pigtail catheter was removed on fourth day of insertion. Serial echocardiographic examinations did not reveal reaccumulation of the fl uid. Presently the patient is one year into the maintenance therapy and has had no recurrence of symptoms and ATT was stopped after six months of therapy. Conclusion Pericardial effusion after start of chemotherapy, when there is no evidence of leukemia, is a rare complication. Awareness of the condition is important in order to make a correct diagnosis.