Voriconazole is a second-generation azole widely used for the prevention and treatment of fungal infection in leukemia patients. We report a case of 9-year-old girl with T-cell acute lymphoblastic leukemia who developed hallucinations and visual disturbance after using voriconazole twice. These symptoms began acutely after treatment with voriconazole and resolved rapidly when the voriconazole was stopped. No specific cause was identified, and thus the symptoms were considered to be the adverse drug reactions (ADRs) of voriconazole. Simultaneous development of hallucinations and visual disturbance caused by voriconazole in children rarely have been reported before and the causes of these ADRs are unknown. Several other cases of hallucinations and (or) visual disturbance caused by voriconazole among 15–81 years old patients have been reported in the literature, and are reviewed. Those patients reminded us of the importance of being aware of hallucinations and visual disturbance associated with voriconazole treatment. In addition, we speculate that the hallucinations and visual disturbance are not related to the dosage form of voriconazole. We emphasize that it is also important to monitor the concentration of voriconazole regularly to avoid potential toxicity.

Leukemia is driven by metabolic reprogramming, yet the specific causal roles of plasma metabolites in distinct leukemia subtypes remain unclear. This study employed Mendelian randomization (MR) to explore potential causal links between 690 plasma metabolites (and 143 metabolite ratios) and four leukemia subtypes: ALL, AML, CLL, and CML. Genetic variants from genome-wide association studies served as instrumental variables. Multiple MR approaches, including IVW, MR-Egger, and Weighted Median, along with sensitivity analyses, were applied to ensure robust results. Our findings revealed subtype-specific metabolite associations. In ALL, metabolites such as 3-Hydroxyisobutyrate and γ-Glutamylglutamate showed positive associations, while Phosphocholine and Ceramide showed negative associations. AML was positively linked to GlcNAc/GalNAc and negatively to 1-Methylnicotinamide. CLL showed positive associations with Butyrate/Isobutyrate and Androstenediol Monosulfate, and negative ones with Docosatrienoate and α-Tocopherol to Sulfate ratio. CML exhibited negative associations with Cysteine-Glutathione disulfide and Piperine. Our MR study provides a comprehensive evaluation of the metabolomic landscape of leukemia, identifying subtype-specific causal associations involving pathways such as energy metabolism, amino acid metabolism, lipid signaling, and redox homeostasis. These findings offer insights into potential plasma biomarkers and therapeutic targets, revealing distinct metabolic vulnerabilities that warrant further investigation for precision treatment strategies across leukemia subtypes.

Objective: To characterize cardiovascular findings in childhood cancer survivors during post-treatment follow-up. Methods: This single-center observational study assessed survivors after completion of treatment and compared available echocardiographic and exercise-related measurements with healthy control data. Clinical assessment, cardiac biomarkers and electrocardiography were also obtained. Receipt of cardiovascular medication at follow-up was examined as an exploratory clinical management outcome. Results: Sixty survivors and 60 healthy controls contributed echocardiographic data; CPET comparisons involved 42 survivors and 14 controls. The median survivor age was 12 years. No survivor had clinical heart failure symptoms. Compared with controls, survivors had higher heart rate and resting blood pressure, less negative LV GLS (−18.8 ± 2.5% vs. −22.5 ± 1.6%), higher mitral E/e (6.2 (5.5, 7.1) vs. 4.9 (4.4, 5.7)), and lower recorded absolute oxygen uptake during exercise (1.2 (0.9, 1.4) vs. 1.5 (1.3, 1.7) L/min). Qualitative cardiac enlargement was reported in 16 survivors; 15 received cardiovascular medication. Previous cardiac events were associated with medication receipt in univariate analysis. In the ALL subgroup, medication receipt was more frequent in the intermediate/high-risk treatment group, which had higher anthracycline exposure; the age-at-diagnosis comparison was not statistically significant (p = 0.054). Conclusions: Selected cardiovascular measurements differed between survivors and healthy controls, suggesting possible subclinical alterations. These findings do not establish clinically defined cardiac dysfunction or a causal effect of cancer treatment. The unadjusted absolute oxygen uptake comparison does not establish impaired exercise capacity. Treatment-related associations were exploratory and did not identify independent predictors.

Objective Periodic fever with aphtha stomatitis, pharyngitis and lymphadenitis (PFAPA) is an inflammatory disease characterized by recurrent fever, which mainly affects children and has a high rate of missed diagnosis in China. This study is set to summarize the clinical features of PFAPA children and to develop a feasible diagnostic method. Methods Base on our previous experience, a two-step method consisting of preliminary assessment with disease recognition and subsequent verification was used when diagnosing PFAPA in children. The clinical data of the PFAPA children diagnosed from June 17, 2020 to November 3, 2022 were collected and summarized, and the two-step diagnostic method was validated according to the CARRA-PFAPA diagnostic criteria. Results A total of 260 children with periodic fever were included in this study, 8 of them did not meet the criteria of suspected PFAPA. Of the rest, 29 lost follow-up and 9 had no more episode during follow-up. One child was excluded from PFAPA by prednisone trial. The children diagnosed with PFAPA had recurrent fever beginning at a median age of 30 months, but diagnosis was made at 13 months later. The cycle duration was 30 days and the attack lasted 4 days. Exudative tonsillitis, oral ulcer, cervical adenitis and abdominal pain were presented in 93.6%, 51.4%, 43.9% and 33.1%, respectively. Leukocytosis and elevated C-reactive protein were presented in 88.6% and 91.2% of the children during fever episode, and all returned to normal when reexamined in the interval. Cytokines were detected in 36 cases during episodes, interleukin-6 increased in all cases, interferon-γ increased in most cases, but all returned to normal during asymptomatic interval. The height and weight of the children were lower than those of normal. 39.5% of the children had a positive family history. If criteria “normal growth and development” removed, only 15 of the 213 children diagnosed with PFAPA did not fulfill the CARRA-PFAPA criteria for less than 6 episodes at the time diagnosing, but all up to the standards in follow-up. Conclusion PFAPA should be considered for children with recurrent fever, especially those with tonsil exudation. The two-step diagnostic method provides the indications for corticosteroid use, and thus may be appropriate in clinical practice.

Background: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, although not rare, is frequently underdiagnosed. This might be related to the fact that some primary care physicians are not familiar with this syndrome. With the application of network technology, internet tools may also be used for remote diagnosis and follow-up of PFAPA. Herein, we present our experience regarding online diagnosis and management, and provide a more detailed clinical profile of PFAPA in children. Methods: All children with long-standing recurrent fever, including those seen at our hospital (clinic group) and those managed through the Haodf.com online consultation platform (online group), were enrolled and followed up. Children diagnosed with PFAPA were retrospectively analyzed, with particular attention to response to corticosteroid therapy during episodes. Clinical manifestations were compared between the two groups. Results: Among 1,211 patients with PFAPA, febrile episodes lasting 4.0 days (3.0, 4.5) recurred at intervals of 30.0 days (20.0, 30.0), accompanied by exudative tonsillitis (85.5%), leukocytosis (88.6%) and elevated C-reactive protein (95.7%). Prednisone aborted episodes within 3.0 hours (1.0, 4.0); however, 54.2% of patients experienced shortened intervals after prednisone treatment, 38.2% showed no change in intervals, and 7.6% had prolonged cycles. Recrudescence within 24~72 hours was observed in 29.0% of patients who received a single low dose of prednisone. Clinical manifestations were generally similar between the clinic and online groups. At the time of diagnosis, children had experienced recurrent episodes for a median of 12.0 months (6.0, 12.0), yet only 18.4% had previously been suspected of or diagnosed with periodic fever or PFAPA. Conclusions: Oral prednisone is highly effective in aborting attacks but may shorten the interval between episodes in most patients. Underdiagnosis remains common. Online diagnosis and follow-up represent feasible and convenient approaches to PFAPA management.