Nduced aseptic meningitis within a patient with acute lymphoblastic leukemia. Int J App Simple Med Res 2022;12:211-3.Submitted: 12-Nov-2021 Revised: 31-Mar-2022 Accepted: 27-May-2022 Published: 26-Jul-Case ReportA 62yearold female using a history of Ph + ALL was initially diagnosed 3 months prior to presentation by bone marrow biopsy (flow cytometry displaying a predominant immature Bcell population expressing CD34, CD19, CD10, cytoplasmic CD79a, and TdT). She underwent induction chemotherapy with hyper cyclophosphamide, vincristine,This is an open access journal, and articles are distributed under the terms from the Inventive Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows other individuals to remix, tweak, and make upon the work non-commercially, provided that acceptable credit is offered and the new creations are licensed under the identical terms.For reprints make contact with: WKHLRPMedknow_reprints@wolterskluwerAddress for correspondence: Dr. Wesley Tang, Department of Health-related Education, Kettering Health-related Center, 3535 Southern Blvd, Dayton 45429, Ohio, USA. E mail: wesley.tang@ ketteringhealth.orgAccess this short article on the web Web-site: ijabmr.org DOI: ten.4103/ijabmr.ijabmr_729_21 Quick Response Code:2022 International Journal of Applied and Basic Medical Analysis | Published by Wolters Kluwer MedknowTang and Tan: Methotrexate-induced aseptic meningitis within a patient with ALLFigure 1: Outpatient intrathecal methotrexate administration 8 days before hospital presentation with spinal stimulator in placeFigure 2: Fluoroscopicguided lumbar puncture below sterile conditionsand she was transfused with one particular unit of packed red blood cells. Her white blood cell count was 6.eight K/uL. Computed tomography imaging of her head was performed and didn’t show any acute procedure. Unfortunately, she was unable to undergo magnetic resonance imaging because of the contraindication of possessing an implanted spinal stimulator for chronic back pain. Neurology was consulted and advisable to start empiric antimicrobial therapy prior to attempting a lumbar puncture on account of her clinical instability. Therefore, the patient was started on cefepime, vancomycin, and ampicillin for empiric bacterial meningitis coverage. She had also been on prophylactic fluconazole and acyclovir dosing on admission and was later escalated to treatmentrelated dosing for acyclovir by infectious disease.TRAT1 Protein supplier A diagnostic lumbar puncture was attempted the next day but was unable to become performed as the patient was confused and couldn’t cooperate with all the procedure.Neurotrophin-3 Protein Molecular Weight She continued to clinically deteriorate by becoming much less responsive, and she was transferred for the intensive care unit (ICU) for closer monitoring.PMID:25818744 She remained agitated, no longer followed commands, and required fast sequence intubation with subsequent mechanical ventilation for airway protection. A lumbar puncture was then performed, however the results were inconsistent with bacterial infectious etiology (24 granulocytes, 60 lymphocytes, and 3 macrophages) [Figure 2]. The cerebrospinal fluid cultures showed no growth and tested negative by means of polymerase chain reaction (PCR) for herpes simplex virus, varicellazoster virus, Lyme disease, and West Nile virus antibodies immunoglobulin G and immunoglobulin M. Infectious illness workup also incorporated a unfavorable upper respiratory panel, influenza testing, and SARSCoV2 PCR. Over the course of various hospital days, the patient gradually improved and remained hemodynamically stable. Following extubation, antimicrobial th.
