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    Bilateral Cytomegalovirus Retinitis in a Child with Rhabdomyosarcoma
    (KARE PUBL, 2017) Zulfikar, Osman Bulent; Emiroglu, Halil Haldun; Kebudi, Rejin; Emiroglu, Melike; Tuncer, Samuray
    Reactivation of cytomegalovirus (CMV) leading to retinitis has been commonly reported in association with human immunodeficiency virus (HIV) infection or iatrogenic suppression of the immune system, including transplant recipients. Rhabdomyosarcoma (RMS) is the most common soft tissue malignancy in the pediatric age group, and alveolar histology is associated with unfavorable outcome. Presently described is case of RMS with alveolar histology in a 12-year-old male who developed CMV bilateral retinitis during prolonged period of neutropenic fever after 40 weeks of chemotherapy. He was diagnosed based on CMV-DNA polymerase chain reaction in blood and urine samples, and responded well to intravenous gancyclovir treatment. A high index of suspicion for reactivation of CMV leading to retinitis should be maintained and, if needed, investigated, not only in patients with HIV infection or transplant recipients, but also all patients who are iatrogenically immunosuppressed, including those who experience prolonged neutropenic fever due to lengthy courses of radiotherapy and chemotherapy.
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    First report of human ehrlichiosis in Turkey
    (TURKISH J PEDIATRICS, 2019) Emiroglu, Melike; Celebi, Bekir
    Ehrlichiosis, a tick-borne infection, can cause severe and fatal disease. A 6-year-old boy was admitted with fever, chills, malaise, headache, anorexia, rhinorrhoea, and cough lasting two days. He had had contact with a dog 10 days prior, and a tick had been removed the day before. Fever, minimal conjunctival injection, oropharyngeal hyperemia and cracked, hyperemic lips were observed. Laboratory tests were normal except for lymphopenia and hyponatremia. Cytoplasmic morulae in the monocytes and granulocytes were seen on peripheral blood smear. Doxycycline was started immediately, and the fever subsided within 48 hours. Given the Ehrlichia was positive but Anaplasma negative by real-time PCR, he was diagnosed as ehrlichiosis, subspecies identification could not be performed. This is the first human ehrlichiosis case in Turkey.
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    High-risk febrile neutropenia and its management in children with solid tumors and lymphoma
    (TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2015) Kose, Dogan; Emiroglu, Melike; Koksal, Yavuz
    Background/aim: The clinical characteristics and treatment results of febrile neutropenia attacks that occurred in patients with lymphoma and solid tumors were analyzed. Materials and methods: A total of 50 patients with 94 high-risk attacks were evaluated for malignant diseases in this study. Results: The fever etiology was determined as clinical (50%), microbiological (5.31%), clinical-microbiological (5.31%), or unknown (39.3%). A few of the attacks (21.3%) were observed in lymphoma cases and 77.7% were observed in patients with solid tumors. Patients who were in remission had 59.6% of the attacks, and 39.4% occurred in patients not in remission. Among the groups tested, 73% (the imipenem/amikacin group) and 47.9% (the piperacillin-tazobactam/amikacin group) of patients were in remission. Glycopeptide addition rates in these groups were 22.2% and 40.8% and antifungal addition rates were 8.8% and 18.3%, respectively. Conclusion: Clinical progress was more problematic in patients who were not in remission during the attacks. This was due to the fact that some patients had other factors that placed them in the high-risk group, as well as increased C reactive protein and procalcitonin values on the first day. Therefore, it may not be accurate to associate the success achieved in the different treatment regimens with antibiotics alone.