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婴儿硬膜下血肿表现为幼年型粒单核细胞白血病。

Juvenile myelomonocytic leukemia presenting in an infant with a subdural hematoma.

机构信息

University of Connecticut School of Medicine, Farmington, CT, USA.

Special Hematology Laboratory, Department of Pathology & Laboratory Medicine, Hartford Hospital, Hartford, CT, USA.

出版信息

Childs Nerv Syst. 2021 Jun;37(6):2075-2079. doi: 10.1007/s00381-020-05013-7. Epub 2021 Jan 6.

Abstract

BACKGROUND

Juvenile myelomonocytic leukemia (JMML) is a rare childhood hematopoietic disorder typically presenting with hepatosplenomegaly, lymphadenopathy, pallor, fever, and cutaneous findings. The authors report the first case, to our knowledge, of JMML presenting in a pediatric patient with a subdural hematoma.

CASE DESCRIPTION

A 7-month old male with recurrent respiratory infections and a low-grade fever presented with a full fontanelle and an increasing head circumference and was found to have chronic bilateral subdural collections. Abusive head trauma, infectious, and coagulopathy workups were unremarkable, and the patient underwent bilateral burr holes for evacuation of the subdural collections. The postoperative course was complicated by the development of thrombocytopenia, anemia, and an acute subdural hemorrhage which required evacuation. Cytologic analysis of the subdural fluid demonstrated atypical cells, which prompted flow cytometric analysis, a bone marrow biopsy, and ultimately a diagnosis of JMML. Following chemotherapy, the patient's counts improved, and he subsequently underwent a hematopoietic stem cell transplant.

CONCLUSION

Subdural collections may rarely represent the first presenting sign of hematologic malignancies. In patients with a history of recurrent infections and a negative workup for abusive head trauma, clinicians should include neoplastic etiologies in the differential for chronic subdural collections and have a low threshold for fluid analysis.

摘要

背景

幼年髓单核细胞白血病(JMML)是一种罕见的儿童造血系统疾病,通常表现为肝脾肿大、淋巴结病、苍白、发热和皮肤表现。作者报告了首例 JMML 病例,据我们所知,该病例发生在一名患有硬膜下血肿的儿科患者中。

病例描述

一名 7 个月大的男性因反复呼吸道感染和低度发热就诊,表现为前囟饱满和头围逐渐增大,发现慢性双侧硬膜下积液。虐待性头部外伤、感染和凝血功能障碍检查均无明显异常,患者接受双侧颅骨钻孔以清除硬膜下积液。术后患者出现血小板减少症、贫血和急性硬膜下血肿,需要进行清除。硬膜下液的细胞学分析显示为异型细胞,这促使进行流式细胞分析、骨髓活检,并最终诊断为 JMML。化疗后,患者的计数有所改善,随后进行了造血干细胞移植。

结论

硬膜下积液可能很少表现为血液系统恶性肿瘤的首发症状。对于反复感染且虐待性头部外伤检查阴性的患者,临床医生应将肿瘤性病因纳入慢性硬膜下积液的鉴别诊断中,并对液体分析的门槛要低。

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