Rare Pancreatitis-Related Complications of L-Asparaginase in Pediatric Acute Lymphoblastic Leukemia: A Case With Pseudocyst and Panniculitis and Literature Review.

Background: L-asparaginase is an essential chemotherapeutic agent for treating pediatric acute lymphoblastic leukemia (ALL), but its use is commonly linked to severe complications, including pancreatitis. Pancreatic pseudocysts and panniculitis are a rare complication of L-asparaginase-induced pancreatitis.

Case presentation: We report the case of a 20-month-old girl diagnosed with pre-B ALL who developed pancreatitis, complicated by pseudocyst formation and panniculitis, following L-asparaginase therapy. The patient had clinical deterioration and the development of a mechanical ventilation requirement; septic shock was initially suspected. However, due to the appearance of cutaneous findings a few days later, radiologic investigations were performed, revealing the formation of intra-abdominal pseudocysts and subcutaneous fat necrosis. Consequently, a delayed diagnosis of pancreatitis was made, which was managed conservatively with a multidisciplinary approach. Eventually, the pseudocyst resolved with close clinical and radiologic monitoring.

Discussion: Pancreatic pseudocyst formation in pediatric oncology patients is uncommon but necessitates prompt recognition and an individualized treatment strategy. Panniculitis secondary to pancreatitis is even rarer and may serve as an early cutaneous clue to underlying pancreatic pathology. Conservative management of pseudocysts, supported by interventional radiology and close follow-up, can be effective in select cases, reducing the risk associated with surgical intervention.

Conclusion: This case underscores the importance of heightened clinical suspicion for pancreatic complications in pediatric patients receiving L-asparaginase. A multidisciplinary team approach is essential for effective diagnosis and treatment. Additional research is warranted to refine treatment guidelines for L-asparaginase-induced pancreatitis and its complications.