Benign stenosis of oesophagus of mycotic aetiology with
the primary diagnosis of acute lymfoblastic leukaemia in
young patients
Svobodová D.1, Klvaňa P.2, Slaný J.1, Blažek B.1, Čuřík R.3
1Klinika dětského lékařství FNsP Ostrava, přednosta: doc. MUDr. Jaroslav Slaný, CSc. 2Interní klinika FNsP Ostrava, přednosta: doc. MUDr. Arnošt Martínek, CSc. 3Ústav patologie FNsP Ostrava, přednosta: MUDr. Romuald Čuřík |
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Summary:
The present study discusses two cases of benign oesophagus
stenosis of mycotic aetiology in two young girls treated
for acute lymphoblastic leukaemia.
Both of them have undergone an intensive treatment by
cytostatics following BFM ALL IC 2002 protocol, i.e. in an
immunodeficient condition, both infected by Candida Albicans
on different scales (positive cultivation from the throat,
urine, vomit, and stool in the 3-year-old, systemic candidosis
affecting the spleen, liver and lungs in the 2-yearold),
accompanied by the positive ELISA anti-gene from
the serum. Consequently, an oesophagus stenosis has been
diagnosed (a filiform stenosis at 15 cm from the incisors in
the 2-year-old: Th 5-6, 8 mm at 20 cm from the incisors in
the 3-year-old;). The condition is successfully controlled by
means of gradual dilatations up to 14–16 mm followed by
possible peroral reception of minced and mushy food. The
endoscopic intervention is here complicated by the children’s
primary disease, by repeated occurrences of febrile
neutropenia, and blocks of chemotherapy during which
invasive operations must be avoided.
The timing of individual dilatations is thus extremely difficult,
they must be carried out very carefully due to the danger
of perforation and in general anaesthesia with respect
to the young patients (in the cases presented the patient-friendly
anaesthetics included isofluran as an inhalant anaesthetic
and propofol – a phenol derivative with an ultrashort
effect as an intravenous anaesthetic, the shortest one
as far as oxidative stress is considered).
Key words:
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