The Marijuana Threat in Leukemia Patients
Methods: We reviewed four leukemia patients at Moffitt Cancer Center with chest imaging findings attributed to marijuana use. Summarized characteristics included patient’s underlying malignancies, clinical presentation, absolute neutrophil count (ANC) at the time of diagnosis, antifungal prophylaxis used, imaging findings and the treatment offered.
Results: Of the four patients, two had acute lymphocytic leukemia (ALL) and two had acute myelogenous leukemia (AML). The two ALL cases were post induction chemotherapy at the time of diagnosis and were on fluconazole prophylaxis. They were found to have nodular pneumonia on CT-scan of the chest suspicious for mold infection. The lesion was cavitary in one patient who had just resolved 1 week of neutropenia. They both received voriconazole and showed resolution of the nodules on repeat CT-scan of the chest. Patients with AML had a miliary nodular pattern on chest imaging studies. The first patient was neutropenic with a productive cough. He had a positive galactomann test and showed progression of his lesions while on micafungin prophylaxis, followed by complete resolution on voriconazole. The second AML patient was not neutropenic at the time of diagnosis. He was started on posaconazole along with chemotherapy. Unfortunately, He expired 2 months later from disseminated Fusarium infection.
Conclusion: We reviewed four cases of nodular pneumonia in leukemic patients who admitted using marijuana and were not receiving anti-mold prophylaxis. Dramatic loss of the fourth patient, and the radiographic resolution on adequate anti-mold therapy in the first three cases confirmed our suspicion. This case series highlights the need to consider anti-mold prophylaxis in patients with leukemia and anticipated neutropenia who smoke marijuana.
A. Velez, None
S. Manivannan, None