A 5 year old girl child presented with a history of fever of 15-day duration and gum bleeding since 1 day.
The fever was high grade, intermittent, and was associated with diffuse aching in her arms, legs, and back since 2 weeks. The child had been active between fever spikes but was refusing to walk since the previous 2 days. She had been treated with intravenous (IV) antibiotics and antimalarial drugs for 1 week before she presented to us. She was noticed to have gum bleeding by her parents on the morning of presentation. The child was irritable and uncooperative. She was afebrile. There was pallor but she did not have icterus, edema or lymphadenopathy. There were large ecchymotic patches on her left lower limb and she also had a few petechiae on her arms and trunk. There was bony tenderness over the shins and the sternum. There was mild hepatosplenomegaly. The rest of the systemic examination was normal.
CBC: Hb 7.4 gm%, TLC 3200 /cmm (P10%, L80%) with no abnormal cells on smear, Platelet count 15000/cmm
Further Evaluation: Bone marrow aspiration and biopsy
Final Diagnosis: Pre B ALL without CNS involvement stratified as Standard Risk
The patient was started on induction chemotherapy along with intrathecal chemotherapy as prophylaxis for CNS spread. She responded well to treatment and achieved molecular remission (minimal residual disease was negative) at end of induction. She completed total treatment of 2 years and is in complete remission.
Dr Sunil P Udgire
Consultant- Pediatric Oncologist, Hematologist and BMT Physician,
Fortis Hospital, Bangalore.
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