The Clinico-Therapeutic Challenge of Tuberculosis in Pediatric Acute Leukemia and Stem Cell Transplant Patients: An Experience From a Tertiary Care Center Over 5 Years

Despite the high prevalence of tuberculosis (TB) in developing countries, tubercular reactivation or new infections are rarely observed in patients with acute leukemia or after hematopoietic stem cell transplant (HSCT). We describe 9 pediatric oncology or post-HSCT patients with TB. The median age was 9 years (range: 1 to 15 y). All leukemia patients (n=8) developed TB during or immediately after induction chemotherapy. The most common symptoms were fever and cough. Co-infection with other microorganisms was observed in 6 cases. Management included first-line antitubercular therapy (ATT) for 4 cases and second-line ATT for 5 patients, with a switch back to first-line ATT as soon as possible. ATT-induced hepatitis was observed in 3 cases. Tuberculosis led to chemotherapy treatment interruption in all cases, with a median duration of 16 days (range: 7 to 28 d). All children responded well to ATT, with defervescence, resolution of effusion, resolution of cough, and radiologic improvement. The study highlights the clinical mimics, diagnostic difficulties, and treatment-related challenges with modifications needed for both TB and cancer when they occur together.