Acute myeloid leukemia presenting as obstructive jaundice

Jaundice as a presenting feature of pediatric acute myeloid leukemia is rare. We report two cases of AML who presented with obstructive jaundice, one with a malignant stricture at the common bile duct and other with a granulocytic sarcoma obstructing the bile duct. The prognosis is poor in these patients.     

Acute myeloid leukemia presenting with diabetes insipidus

A central diabetes insipidus should be considered as a sign of primary CNS involvement in patients with acute myeloid leukemia even in the case of normal cerebrospinal fluid and magnetic resonance imaging findings.     

Acute myeloid leukemia presenting as spinal cord compression

We report the findings of a 10-year-old boy who presented to a pediatric emergency department with symptoms of spinal cord compression. Radiological imaging demonstrated multiple soft tissue masses in the head and spine. The surgical pathology showed that the masses were comprised of myeloid leukemia cells. These findings were consistent with those observed on bone marrow aspiration. The characteristics and management of extramedullary leukemia are discussed.     

Haemophilus influenzae epiglottitis occurring simultaneously in two siblings

Intrafamilial spread ofHaemophilus influenzae typ B disease has often been described for meningitis, but rarely for epiglottitis. Here we report for the first time epiglottitis occurring simultaneously in two siblings and comment on the value of chemoprophylaxis and vaccination to prevent secondary and primary disease.     

Acute myeloid leukemia

Acute myeloid leukemia (AML) is a heterogeneous group of leukemias that result from clonal transformation of hematopoietic precursors through the acquisition of chromosomal rearrangements and multiple gene mutations. As a result of highly collaborative clinical research by pediatric cooperative cancer groups worldwide, disease-free survival has improved significantly during the past 3 decades. Further improvements in outcomes of children who have AML probably will reflect continued progress in understanding the biology of AML and the concomitant development of new molecularly targeted agents for use in combination with conventional chemotherapy drugs.     

Acute arsenic poisoning in two siblings

We report a case series of acute arsenic poisoning of 2 siblings, a 4-month-old male infant and his 2-year-old sister. Each child ingested solubilized inorganic arsenic from an outdated pesticide that was misidentified as spring water. The 4-month-old child ingested a dose of arsenic that was lethal despite extraordinary attempts at arsenic removal, including chelation therapy, extracorporeal membrane oxygenation, exchange transfusion, and hemodialysis. The 2-year-old fared well with conventional therapy.     

Acute myeloid leukemia in TAR syndrome

TAR syndrome is a rare inherited.autosomal recessive disorder with a mortality rate of 30–40% mainly as a result of haemorrhage, in the first year of life. Most of the infants recover from the effects of thrombocytopenia and associated haematological complications with the modern medical care. Very rarely, the outcome is fatal, with the occurrence of acute leukemias.     

Acute leukemia presenting as arthritis in children

The clinical and laboratory features of six children with arthritis as the presenting manifestation of acute leukemia are reviewed. Asymmetric arthritis involving the large joints of the extremities was the dominant clinical feature in all patients. Despite the presence of antinuclear antibody in three patients, other laboratory features, particularly hematologic abnormalities, served as clues to the diagnosis of leukemic arthropathy in most patients.     

Acute lymphoblastic leukemia presenting with typhlitis

We report an unusual case of acute lymphoblastic leukemia (ALL) that presented as right lower quadrant pain in a 17-year-old boy. Ultrasonographic findings were consistent with typhlitis. The clinical and imaging symptoms resolved upon treatment with antibiotics and conservative care, only to recur after initiation of chemotherapy. Familiarity with the clinical presentation and imaging findings of typhlitis is important for its correct diagnosis and management. Med. Pediatr. Oncol. 28:209–212 © 1997 Wiley-Liss, Inc.     

Acute lymphoblastic leukemia presenting in fulminant hepatic failure

A previously healthy 4-year-old boy was admitted because of acute liver failure. He was icteric, lethargic, had elevated ammonia and abnormal liver function tests. Serology was negative for viral hepatitis. There was no history of hepatotoxic drugs. Family history was unremarkable. The child was taken to the operating room for a living-related hepatic transplant. Frozen section showed massive hepatic leukemic infiltration and hepatocellular necrosis. Bone marrow aspiration confirmed the diagnosis of acute lymphoblastic leukemia (ALL). Transplant was withheld and chemotherapy was attempted. He died the following day due to systemic leukemic infiltration, cerebral edema, and severe anoxic ischemic encephalopathy.     

Acute lymphoblastic leukemia presenting as cyclic neutropenia

Clinical and laboratory parameters usually allow an easy diagnosis of acute lymphoblastic leukemia in most cases. Difficulty arises, however, when presentation is atypical. A young child with membranous tonsillo-pharyngitis secondary to an isolated neutropenia is reported. The neutrophilic count later showed fluctuations reminiscent of cyclic neutropenia. Bone marrow examination revealed the true nature of underlying disorder.     

Cat-scratch disease occurring in three siblings simultaneously

We report for the first time three siblings with cat-scratch disease occurring simultaneously. Case 1 was an 8-year-old boy with enlarged supraclavicular lymph nodes and fever. Case 2 was the 11-year-old sister whose presentation was a prolonged febrile illness. Case 3 was a 13-year-old male adolescent with adenitis of the neck and thigh. All three patients were treated with rifampin with improvement of their symptoms.     

Acute lymphoblastic leukemia presenting with gross hematuria

A case of a six-year-old boy presenting with gross hematuria is reported. Investigations revealed the etiology of the hematuria to be thrombocytopenia in the setting of newly diagnosed acute lymphoblastic leukemia. The diagnosis of leukemia was confirmed by bone marrow examination. The patient’s hematuria completely resolved with platelet transfusions. Although thrombocytopenia is a very common presenting feature of acute lymphoblastic leukemia, gross hematuria is exceedingly rare. Thus, thrombocytopenia potentially caused by acute leukemia should be considered in a child presenting with gross hematuria.