Unusual Presentation of Childhood Leukemia With Vaginal Bleeding: A Case Report

Abstract

Introduction: This case report describes a 17-year-old female patient who initially presented with vaginal bleeding, weight loss, and nonspecific symptoms, which led to the diagnosis of B-cell acute lymphoblastic leukemia (B-ALL). This unusual presentation highlights the importance of considering hematological malignancies in patients with atypical symptoms. Case Presentation: The patient, married for 2 weeks, experienced vaginal bleeding following her first sexual intercourse, which did not resolve spontaneously. She also reported a 6 kg weight loss over the past 3-4 months, hair loss, and a history of dysmenorrhea and an ovarian cyst detected 2 years prior. Laboratory investigations revealed leukocytosis (WBC: 16,500/μL), anemia (Hb: 11.4 g/dL), and thrombocytopenia (Plt: 44,000/μL). Bone marrow aspiration (BMA) and flow cytometry confirmed the diagnosis of B-ALL, revealing a high percentage of atypical lymphoid cells. Discussion: This case underscores the rarity of diagnosing hematological malignancies in patients with vaginal bleeding. The patient's symptoms, including weight loss and thrombocytopenia, should have prompted a more comprehensive evaluation. Early recognition of B-ALL is crucial as prompt treatment significantly improves outcomes. The patient was started on prednisolone and alkalinized fluids, and her condition was closely monitored. Conclusion: Vaginal bleeding in young patients should not be dismissed as a minor issue, especially when accompanied by other systemic symptoms like weight loss and thrombocytopenia. Early diagnosis of B-ALL in such cases can lead to better management and prognosis.

Keywords: B-cell acute lymphoblastic leukemia; case report; thrombocytopenia; vaginal bleeding.

Figure 1

Bone marrow smear showing L2-type blasts with mirror image-like morphological features.

Figure 2

Flow cytometry analysis of bone marrow sample. Flow cytometry analysis demonstrating CD45 and CD19/CD10 expression patterns. (a) CD45 gating, highlighting 78.85% of the blast population. (b) CD19 and CD10 coexpression, with 96.47% of the gated cells positive for both markers, supporting the diagnosis of B-cell acute lymphoblastic leukemia (B-ALL).