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Ocular hemorrhage secondary to thioguanine‐associated veno‐occlusive disease in a child with acute lymphoblastic leukemia in delayed intensification
Author(s) -
Bhunia Nabanita,
Yeager Nicholas D.,
Colace Susan I.,
Buzzaco Dominic,
Bajwa Rajinder P. S.
Publication year - 2020
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13638
Subject(s) - medicine , complication , hepatic veno occlusive disease , blindness , refractory (planetary science) , disease , lymphoblastic leukemia , pediatrics , transplantation , surgery , chemotherapy , eye disease , hematopoietic stem cell transplantation , leukemia , physics , astrobiology , optometry
Hepatic VOD is a potentially fatal complication during stem cell transplantation and is rarely seen in the non‐transplant setting. We report the case of a five‐year‐old boy who presented with visual complaints during delayed intensification phase of treatment for ALL. He was found to have bilateral retinal hemorrhages associated with profound thrombocytopenia due to chemotherapy. VOD was diagnosed based on EBMT criteria and was managed with supportive care. Despite resolution of VOD, his vision progressively deteriorated and resulted in blindness. This case highlights the significance of close monitoring of ALL patients in delayed intensification when they are at risk for developing VOD, the importance of refractory thrombocytopenia as a diagnostic feature and the potential for VOD to manifest with intraocular bleeding.