Bilateral Cavitary Pulmonary Consolidations in a Patient Undergoing Allogeneic Bone Marrow Transplantation for Acute Leukemia

A 10-year-old boy developed severe dyspnea and respiratory failure during a hospitalization for an allogeneic unrelated bone marrow transplantation for acute myeloid leukemia. He had first presented 23 weeks earlier with acute myeloid leukemia and had not responded to the initial induction chemotherapy. Next, he was successfully treated with another regimen of remission-induction chemotherapy without complications. He received an allogeneic unrelated bone marrow transplant after a conditioning regimen of cyclophosphamide (Endoxan; AstaMedica BV; Diemen, the Netherlands) therapy, total body irradiation, and low-dose antithymocyte globulin. Both donor and recipient were seronegative for cytomegalovirus. Immediately after transplantation, the patient received therapy with cyclosporine A, short-course methotrexate, and total bowel decontamination. During this time, he was nursed in a protective environment. Seven days after undergoing the bone marrow transplantation, he developed a fever. A blood culture revealed a coagulase-negative Staphylococcus infection for which he was treated with IV antibiotics (ceftazidime and teicoplanin). Six days later (13 days after the bone marrow transplantation), a chest radiograph showed bilateral pulmonary infiltrates (Fig 1).