Journal article
Selumetinib for Refractory Pulmonary and Gastrointestinal Bleeding in Noonan Syndrome
Pediatrics (Evanston), Vol.150(4), p.1
10/01/2022
DOI: 10.1542/peds.2022-056336
Abstract
A 15-year-old-boy with Noonan syndrome and status post orthoptic heart transplant developed mixed mitral valve disease and underwent mechanical mitral valve replacement 6 months before presentation with acute respiratory distress. He developed massive pulmonary hemorrhage that required veno-venous extracorporeal membrane oxygenation (ECMO) support. He had a prolonged anticoagulation free ECMO course of 4 weeks, with ongoing recurrent pulmonary hemorrhage and underwent several rounds of coil embolization of aortopulmonary collaterals. ECMO course was complicated by significant nasopharyngeal bleeding that required embolization of the sphenopalatine artery. Shortly after decannulation, he developed massive gastrointestinal and peritoneal hemorrhage that was treated by embolization of the left gastric artery and a branch of the internal iliac artery. His bleeding was attributed to neo-angiogenesis. Initial treatment with propranolol was unsuccessful. Subsequent treatment with interferon α 2b demonstrated efficacy, but severe neutropenia required cessation of therapy. Because functional alterations of the rat sarcoma virus-mitogen activated protein kinase signaling pathway and protein tyrosine phosphatase nonreceptor type (PTPN11) mutations in Noonan syndrome are known to be associated with neo-angiogenesis, we used the mitogen-activated protein kinase inhibitor selumetinib as a gene-targeted therapy with the hope of controlling bleeding and inhibiting neo-angiogenesis. After initiation of selumetinib, bleeding stopped and allowed the patient to be discharged from the hospital on dipyridamole as antiplatelet prophylaxis for his mechanical mitral valve. He had no further bleeding episodes through 1 year after hospital discharge.
Details
- Title: Subtitle
- Selumetinib for Refractory Pulmonary and Gastrointestinal Bleeding in Noonan Syndrome
- Creators
- Abhishek Chakraborty - Le Bonheur Children's HospitalGary Beasley - Le Bonheur Children's HospitalHugo Martinez - Le Bonheur Children's HospitalRohith Jesudas - St. Jude Children's Research HospitalPilar Anton-Martin - Le Bonheur Children's HospitalGeorgios Christakopoulos - St. Jude Children's Research HospitalJennifer Kramer - Le Bonheur Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Pediatrics (Evanston), Vol.150(4), p.1
- Publisher
- American Academy of Pediatrics
- DOI
- 10.1542/peds.2022-056336
- ISSN
- 0031-4005
- eISSN
- 1098-4275
- Language
- English
- Date published
- 10/01/2022
- Academic Unit
- Stead Family Department of Pediatrics; Cardiology
- Record Identifier
- 9984353800702771
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