Diagnostic Dilemma of JMML Coexisting with CMV Infection

Juvenile myelomonocytic leukemia (JMML) is a rare mixed myeloproliferative and myelodysplastic disorder of early childhood, characterized by excessive proliferation of monocytic and granulocytic cells, along with myelodysplastic features. There are reports of viral infections mimicking JMML, with all clinical and hematological parameters normalizing on resolution of infection. The authors describe a 1- year- old boy with concomitant JMML and CMV infection. The diagnostic dilemma, the significance of distinguishing it from a mimicking viral infection, as well as potential synergistic effect of concomitant infections on the presentation or actual disease severity of underlying JMML will be discussed.