Broomall, Eileen

We report the case of a previously healthy, 6-year-old boy who presented with 2 days of generalized body aches. Given a recent viral illness with cough and congestion, the emergency department’s initial diagnosis of the condition was viral myositis. He was admitted for pain treatment. During his hospitalization, he developed worsening pain, decreased mobility, and intermittent nocturnal desaturations. The team elicited additional history of snoring and witnessed apneas, which raised concern for obstructive sleep apnea. They consulted pulmonology who was concerned for central sleep apnea and respiratory depression and recommended consulting neurology. Neurology recommended a lumbar puncture, the results of which led to the eventual diagnosis. This case highlights the importance of critical reasoning and knowledge of the pediatric presentation of diseases that affect both adults and children.

High-dose methotrexate has been a treatment for osteosarcoma; however, its nephrotoxic effects are considerable. Carboxypeptidase-G2 (glucarpidase) was approved by the US Food and Drug Administration in 2012 for treatment of toxic methotrexate levels. We report our experience using glucarpidase under compassionate use before Food and Drug Administration approval in 2 patients who had delayed methotrexate clearance and prolonged kidney injury despite glucarpidase administration. Our results show that patients with methotrexate toxicity may require repeated doses of glucarpidase in addition to supportive measures, such as dialysis.