ABSTRACT
Granulomatous lung disease is a rare and perplexing differential in pediatrics. Pulmonary Cryptococcus falls into the differential but is not high on the list, particularly in a non-AIDS patient. Methotrexate (MTX) is a commonly used agent for chemotherapy in oncology and has been documented to cause lung injury in both patients with rheumatologic and oncologic diseases. Our patient had chronic cough and then developed an opportunistic infection resulting in respiratory failure. Lung biopsy showed two underlying unusual diagnoses: MTX lung injury and cryptococcal pneumonia. His case is presented with particular attention to his prolonged road to diagnosis.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cryptococcosis/chemically induced , Lung Diseases/chemically induced , Opportunistic Infections/chemically induced , Pneumonia/chemically induced , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Child , Cryptococcosis/diagnosis , Cryptococcosis/microbiology , Cryptococcus neoformans/isolation & purification , Humans , Lung Diseases/diagnosis , Lung Diseases/microbiology , Male , Opportunistic Infections/diagnosis , Opportunistic Infections/microbiology , Pneumonia/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , PrognosisABSTRACT
Prevalence of brain arteriovenous malformation ranges from 0.14% to 0.6% according to various estimates. A large number of these patients remain asymptomatic. The most common presentation is due to brain hemorrhage. A 14-year-old girl presented to the pediatrician with erratic behavior issues and hallucinations. She was diagnosed by the pediatrician and mental health facility as having schizophrenia and bipolar disorder. Once she was transferred to our children's hospital, evaluation by a pediatric neurologist, computed tomography scan, magnetic resonance imaging, and laboratory workup including lumbar puncture confirmed a clinically isolated syndrome and frontal lobe arteriovenous malformation. Frontal lobe lesions including arteriovenous malformation in the frontal lobe can cause psychological symptoms and behavioral issues. We also discuss the differential diagnosis of acute demyelinating syndromes.