Acute respiratory distress syndrome due to tuberculosis in a child after allogeneic bone marrow transplantation for acute lymphoblastic leukemia

We report the occurrence of tuberculosis in a 10-year-old Taiwanese boy, ap proximately 4 months after he received a matched-related bone marrow transp lantation from his sister for acute T-cell lymphoblastic leukemia. After tr ansplantation, grade III acute graft-versus-host disease developed and the patient was treated with prednisolone and cyclosporine. Marrow failure was noted on day 77 post-transplantation, however, after an episode of herpes t ester infection. Interstitial pneumonia, diagnosed oil the basis of chest x -ray and computed tomography findings, occurred on day 120. Histologic exam ination of an open-lung biopsy specimen showed caseating granulomas and a f ew acid-fast bacilli. The patient died of acute respiratory distress syndro me, despite immediate implementation of antituberculosis therapy. Sputum cu ltures grew il Mycobacterium tuberculosis 5 weeks later. This report demons trates that the possibility of tuberculosis needs to be considered in immun ocompromised patients, and that appropriate prophylaxis should be institute d in areas where tuberculosis is endemic.