RSV는 2세 미만의 소아에서 급성 하기도 감염으로 인한 입원의 주원인이다. 특히 미숙아, 선천성 심폐질환, 면역결핍이 동반된 경우 주요 위험군으로 알려져 있다. 고위험군의 소아에서 중증 RSV 감염의 경우 리바비린 흡입요법이 허가가 되어 있으나 고비용, 안전성 등의 문제로 국내 임상에서의 사용은 매우 제한적인 실정이다. 저자들은 8개월 여환이 급성 림프구성 백혈병으로 관해유도요법 항암치료 중 발생한 RSV 폐렴으로 기흉, 기종격동, 호흡부전이 동반된 중증 감염을 경험하였다. 정맥용 면역글로불린, 경구 리바비린 투여에 반응이 없어 리바비린 흡입 치료를 시행하였고, 이후 임상적 호전을 경험하였기에 보고하는 바이다.
RSV는 2세 미만의 소아에서 급성 하기도 감염으로 인한 입원의 주원인이다. 특히 미숙아, 선천성 심폐질환, 면역결핍이 동반된 경우 주요 위험군으로 알려져 있다. 고위험군의 소아에서 중증 RSV 감염의 경우 리바비린 흡입요법이 허가가 되어 있으나 고비용, 안전성 등의 문제로 국내 임상에서의 사용은 매우 제한적인 실정이다. 저자들은 8개월 여환이 급성 림프구성 백혈병으로 관해유도요법 항암치료 중 발생한 RSV 폐렴으로 기흉, 기종격동, 호흡부전이 동반된 중증 감염을 경험하였다. 정맥용 면역글로불린, 경구 리바비린 투여에 반응이 없어 리바비린 흡입 치료를 시행하였고, 이후 임상적 호전을 경험하였기에 보고하는 바이다.
Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea,...
Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea, we report one case of RSV pneumonia that developed in an infant with acute lymphoblastic leukemia (ALL). Despite administration of oral ribavirin and intravenous immunoglobulin, the patient's respiratory distress worsened and admission to an intensive care unit was necessary. Chest x-ray showed multifocal consolidation, pneumothorax, and pneumomediastinum. Treatment with aerosolized ribavirin led to significant clinical improvement. The role of aerosolized ribavirin is still controversial, but it might have a therapeutic potential for severe RSV pneumonia in children with leukemia.
Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea, we report one case of RSV pneumonia that developed in an infant with acute lymphoblastic leukemia (ALL). Despite administration of oral ribavirin and intravenous immunoglobulin, the patient's respiratory distress worsened and admission to an intensive care unit was necessary. Chest x-ray showed multifocal consolidation, pneumothorax, and pneumomediastinum. Treatment with aerosolized ribavirin led to significant clinical improvement. The role of aerosolized ribavirin is still controversial, but it might have a therapeutic potential for severe RSV pneumonia in children with leukemia.
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제안 방법
Ribavirin was administered over 18 hours every 24 hours for 3 days. Cardiorespiratory monitoring including electrocardiogram and pulse oximetry was provided for the patient. During the course of therapy with ribavirin, the patient tolerated the medication, without specific side- effects such as bronchospasm and hemolytic anemia.
. In our patient, RSV PCR was performed each week, and RSV positivity was shown for 37 days. Further studies about the association between the treatment of ribavirin and the duration of viral shedding will be needed.
1B). Laboratory findings were as follows: hemoglobin of 10.7 g/dL; white blood cell (WBC) count of 1,100/mm3(neutrophil 24 %, lymphocyte 74%, monocyte 2%); and a platelet count of 68,000/mm3. C-reactive protein (CRP) was 0.
By day 5 of IVIG therapy, the high-grade fever disappeared, but the patient’s clinical condition was deteriorating. She presented with tachypnea, irritability, and chest wall retraction. The chest x-ray on follow-up revealed pneumothorax and pneumomediastinum, and a chest tube was inserted (Fig.
대상 데이터
An 8-month-old infant with acute lymphoblastic leukemia (ALL) was transferred to our institution for chemotherapy. She was born by normal vaginal delivery at 38 weeks of gestation with a birth weight of 3.15 kg. There was no previous history of illness, and the familial history was unremarkable.
성능/효과
There was a new infiltrate on chest radiograph. Laboratory findings revealed hemoglobin of 10.1 g/dL, WBC count of 22,000/mm3(neutrophil 81%, lymphocyte 11%, monocyte 7.2%), platelet count of 113,000/mm3, and CRP was 0.1 mg/dL. Culture was negative for bacteria, Mycobacterium species, and fungi.
후속연구
In our patient, RSV PCR was performed each week, and RSV positivity was shown for 37 days. Further studies about the association between the treatment of ribavirin and the duration of viral shedding will be needed.
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