Gonzalez Laura K, Malhotra Sonali, Levine Marla, Jacobson-Dickman Elka
From the *Division of Pediatric Emergency Medicine, Department of Emergency Medicine, and †Division of Pediatric Endocrinology, Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY.
Pediatr Emerg Care. 2017 Aug;33(8):e27-e29. doi: 10.1097/PEC.0000000000000558.
Herein, we report a case of a 12-year-old girl who presented with diabetic ketoacidosis and a leukemoid reaction. Although this association has been described in a few adult patients, pediatric cases have not been reported. A leukemoid reaction is commonly defined as an elevation in the white blood cell count greater than 50,000/μL in response to severe illness or stress other than hematologic malignancy; it is considered to be mediated by various hormones, cytokines, and factors that are released in response to inciting triggers, such as acidosis. As highlighted in our report, distinguishing a benign leukemoid reaction from a hematologic malignancy and even tumor lysis syndrome, particularly in a setting of diabetic ketoacidosis, is crucial to ensuring safe and efficacious therapeutic interventions.
