Methotrexate (MTX) intrathecal and intravenous administration is associated with neurotoxicity. We report a 15-year old girl diagnosed with large cell B lymphoma. On eighteen-day after intrathecal MTX presented stroke-like symptoms. Magnetic resonance was informed as a possible stroke in the right frontal lobe. The patient does not meet the criteria for fibrinolysis. MTX neurotoxicity was suspected, and theophylline was initiated. She showed complete recovery after three days of treatment. After describing the case, we review MTX neurotoxicity cases from our centre from January 2010 to December 2018. Also, we added to this data the previously published cases in the literature.

During first wave of the COVID pandemic, infection prevention measures were enforced at our Pediatric Neuro-Oncology unit. A retrospective study analysing patients booked in this unit during lockdown was performed to describe its performance. There were 438 consultations for 123 patients (320 on-site/118 telephone). Eight new diagnoses, with one significant delay. Only one patient tested positive for SARS-COV2. Delay in imaging testing occurred in 15 patients. Chemotherapy was delayed in one case and not in radiotherapy. Measures implemented were effective in minimizing the risk of COVID-19 infection, achieving continuity in diagnoses and treatment and avoiding delays that could impact survival.

Background: Controversy surrounds the routine use of urine culture (UC) in febrile neutropenic children. We aimed to evaluate the need for routine urine studies in febrile neutropenic children with cancer. Procedure: We conducted a prospective study of pediatric cancer patients with urinary continence who presented to the emergency department with febrile neutropenia between 2019 and 2021. Epidemiologic data and clinical and laboratory findings were collected. Urinary tract infection (UTI) was defined as urinary signs/symptoms and positive UC with or without pyuria. Study data were analyzed using descriptive statistics. The diagnostic performance of urinalysis was calculated using positive UC as the gold standard. Results: Positive UC was found in seven of the 205 children included (3.4%; 95% CI 1.4-6-9%), 2 presenting urinary symptoms. UTI prevalence was 1.0% (95% CI 0.1-3.5). A 23.8% prevalence of positive UC was found in patients with urinary symptoms and/or history of urinary tract disease (95% CI 8.2-47.2%) as compared to 1.1% of those without symptoms or history (95% CI 0.1-3.9%) (p<0.001). The sensitivity, specificity, negative predictive value, and area under the curve for urinalysis was 16.7% (95% CI 3.0-56.4), 98.4% (95% CI 95.3-99.4), 97.3% (95% CI 93.9-98.9), and 0.65 (95% CI 0.51-0.79), respectively. Conclusions: UTI is an infrequent cause of infection in these patients. Urinalysis is indicated only in febrile neutropenic children with urinary signs/symptoms and in asymptomatic patients with a history of urinary tract disease. When urine is collected, UC should be requested regardless of the result of the urinalysis.

Background: Since the beginning of SARS-CoV-2 pandemic, it has been widely recognized that children and adolescents seem to have milder clinical courses as compared to adult counterparts. However, there is concern that vulnerable collectives including pediatric patients treated for cancer or under immunosuppression may be at higher risk. Methods: We retrospectively collected Spanish COVID-19 cases in children and adolescents with solid and hematological malignancies, non-malignant chronic hematologic conditions, and post allogeneic-stem cell transplantation, from the beginning of the pandemic on January 31 to April 24, 2020. Results: We included 47 cases with RT-PCR positive COVID-19 from 41 centers in Spain, where 97.6% of pediatric patients are treated for cancer. In most cases (76.6%), infection was asymptomatic, or symptoms were mild. Severe illness was observed in 14.9% of cases with respiratory distress and/or hypoxemia, and 8.5% required admission to the PICU. Symptomatic patients received supportive care associated with antiviral and immunomodulatory agents depending upon severity. Anticancer therapy was withhold in the majority of cases during the infection course. Most patients recovered from COVID-19. Two deaths were reported. Conclusion: In our cohort, most children receiving anticancer chemotherapy presented a mild clinical course and had a good outcome. Highly immunosuppressed patients with major comorbidities were at higher risk of severe infections. Among this fragile collective, individualized expert discussion is critical for anti-infectious therapy and appropriate anticancer treatment.