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Case Reports
. 2023 Mar 9;85(3):447-450.
doi: 10.1097/MS9.0000000000000140. eCollection 2023 Mar.

Unusual initial presentation of childhood acute lymphoblastic leukemia as massive ascites and pleural effusion in post-COVID-19 setting: a case report

Oadi N Shrateh  1 , Afnan W M Jobran  1 , Haneen Owienah  2 , Rabee Adwan  3 , Yasmin Dwikat  4 , Mohammad Najajreh  5
Affiliations
Case Reports

Unusual initial presentation of childhood acute lymphoblastic leukemia as massive ascites and pleural effusion in post-COVID-19 setting: a case report

Oadi N Shrateh et al. Ann Med Surg (Lond). .

Abstract

Acute lymphoblastic leukemia (ALL) in children typically presents with nonspecific manifestations such as fever, fatigue, lethargy, joint and bone pain, and bleeding diathesis. Ascites and pleural effusion as an initial presentation of ALL, although described, is exceedingly rare. However, this unusual initial presentation becomes much rarer in the post-coronavirus disease 2019 (COVID-19) setting. Herein, we aim to highlight such a rare initial presentation of childhood ALL that warrants clinical attention.

Case presentation: Two months following a COVID-19 infection, a 3-year-old male patient presented to the hospital with severe abdominal distention associated with occasional dyspnea. Physical assessment revealed a critically ill and pale patient with a distended abdomen and decreased air entry on the right side of the chest. Laboratory testing showed pancytopenia. Imaging studies confirmed the presence of massive ascites and pleural effusion. Bone marrow aspiration revealed CD10-positive pre-B-cell ALL. The patient was treated with chemotherapy and achieved complete remission.

Conclusion: Rare manifestations of relatively common diseases create a barrier to prompt and effective detection and medical intervention. Although ascites and pleural effusion are rare conditions in ALL children patients, the occurrence of these pathologies in this particular patient, especially following COVID-19 infection, is an exceedingly rare event.

Keywords: COVID-19 infection; acute lymphoblastic leukemia; ascites; case report; pleural effusion.

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Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this article.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Computed tomography scan of (A) the chest showing right-sided pleural effusion, (B) the abdomen showing massive amounts of ascitic fluid, and (C) the abdomen showing hepatomegaly.
See this image and copyright information in PMC

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