ECMO Support in Pre-B-Cell ALL for Disseminated Legionnaire's Disease

Abstract

Legionella pneumophila is a common cause of community- and hospital-acquired pneumonia. Its increasing frequency and reemergence as a pathogen of interest in the intensive care unit is likely due to increased awareness, recognition, and diagnostic test availability (1). Extracorporeal Membrane Oxygenation (ECMO) is increasingly used in the pediatric intensive care unit (PICU) for refractory cardiopulmonary failure and acute respiratory distress syndrome (ARDS) in concert with conventional modalities or when these have failed to adequately support the patient. The breadth of applications for this technology are ever-expanding as our collective knowledge and experience grows. With a particularly high mortality rate among immunocompromised patients, Legionnaires' disease should be considered early in the differential diagnosis and appropriate antimicrobials initiated (1). We present the case of an adolescent patient with pre-B-cell acute lymphoblastic leukemia (pre-B ALL) requiring ECMO support for septic shock and ARDS due to disseminated Legionella. To our knowledge, this is the first case describing an immunocompromised pediatric patient supported with ECMO for Legionnaires' disease.

Keywords: ECMO; Legionella; critical care; extracorporeal membrane oxygenation; immunocompromised; pediatrics.

Figure 1.

Stat head CT was performed, which showed large right parenchymal hematoma (5 cm) with intraventricular decompression and evolving acute hydrocephalus, effacement of sulcal spaces, sylvian fissure, basal cisterns, and crowding of posterior fossa structures with 3 cm leftward midline shift.

Figure 2.

(left) Outflow graft and arterial cannula on subclavian artery and (right) schematic diagram of subclavian artery cannulation as an outflow of extracorporeal membrane oxygenation circuit. Used with permission from Kervan U, Kocabeyoglu S, Sert DE, et al. Exp Clin Transplant. 2017;15:658–63.