Browsing by Author "Belsky, Jennifer"

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    Confounding Histoplasmosis in Hodgkin’s Lymphoma
    (2022-03-24) Zhou, Shannon; Friel, Rylee; Holohan, Maggie; Geers, Erica; Alali, Muayad; Belsky, Jennifer
    Case Description: A 17-year-old, black female was diagnosed with Hodgkin’s Lymphoma (HL), confirmed with lymph node biopsy. Initial infectious workup was negative for Histoplasmosis capsulatum (H. capsulatum), and she was started on routine chemotherapy. After 2 cycles of chemotherapy, routine 18FDG/PET scan demonstrated reduction in previous mediastinal adenopathy, but new areas of adenopathy. Due to concern of disease progression in conjunction with new fevers and dyspnea, she had a biopsy which histologically confirmed H. capsulatum with positive IgG and IgM. She was started on antifungal therapy with dose reduction of chemotherapy. FDG/PET scan 5 weeks into antifungal therapy demonstrated continued FDG uptake in previous H. caspulatum concerning areas, and she was continued on both chemotherapy and antifungal therapy. Radiation to her mediastinal mass and persistent areas of FDG uptake is under discussion. Conclusion: Hodgkin lymphoma (HL) is the most common form of lymphoma and classically presents in late adolescent females as lymphadenopathy. 18FDG/PET scans are used to visualize malignant tissue and aid in staging and end of treatment assessment. We present a case of HL whose case was complicated by concurrent H. capsulatum infection, creating a clinical conundrum regarding treatment. Clinical Significance: Acute H. capsulatum infection can appear as a pulmonary consolidation and/or lymphadenopathy with FDG avidity, making it difficult to discern infection from malignancy. This often results in biopsy, chemotherapy reduction, and ambiguity regarding future radiation therapy. Future research should focus on more FDG sensitive tracers to differentiate malignant tissue from infectious or inflammatory tissue. In addition, immunosuppression in the setting of chemotherapy puts patients at risk for opportunistic infections such as H. capsulatum. Screening for opportunistic disease in endemic areas before initiating chemotherapy should be considered.
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    Constipation and GI diagnoses in children with solid tumours: prevalence and management
    (BMJ, 2022-08-30) Belsky, Jennifer; Stanek, Joseph; Yeager, Nicholas; Runco, Daniel; Pediatrics, School of Medicine
    Objectives Despite continued development of targeted therapies for children with cancer, patients continue to experience an array of unwanted side effects. Children with solid tumours may experience constipation as a result of vinca alkaloid therapy, psychological stressors, periods of inactivity and opioid use. Our objective was to investigate the prevalence and treatment of constipation in hospitalised children with solid tumours treated with chemotherapy. Methods We retrospectively analysed data from 48 children’s hospitals in the Pediatric Health Information System, extracting patients 0–21 years of age with a solid tumour diagnosis hospitalised from October 2015 through December 2019. Results We identified 13 375 unique patients with a solid tumour diagnosis receiving chemotherapy. Constipation was the most common gastrointestinal complaint with 8658 (64.7%; 95% Cl: 63.9% to 65.5%) having a constipation diagnosis or having received at least two laxatives during admission. Bone cancers had the highest percentage (69.9%) of patients with constipation, while Hodgkin’s lymphoma had the lowest, although 52.1% of patients were affected. A total of 44% (n=35 301) of encounters received an opioid at some point during admission. Of patients receiving constipation medications, the most commonly prescribed was polyethyl glycol (n=25 175, 31.7%), followed by docusate (n=11 297, 14.2%), senna (n=10 325, 13.0%) and lactulose (n=5501, 6.9%). Conclusions Constipation is the most common gastrointestinal issue that children with solid tumours experience while receiving chemotherapy in the inpatient setting. Increased attention should be given to constipation prophylaxis and treatment in children with solid tumours undergoing chemotherapy, particularly those identified as high risk.