Abstract
IntroductionMalignancy is a rare cause of acquired torticollis in children, and spinal cord involvement from hematolymphoid malignancies is similarly unusual. Neurologic abnormalities may not be present on initial evaluation, and delayed diagnosis and treatment is associated with increased risk of permanent paralysis.Case ReportThe author describes a case of isolated torticollis in a 2-year-old evaluated multiple times in the emergency department (ED) and outpatient settings. For her first three presentations, the patient had no associated neurologic abnormalities. She was discharged with return precautions and a presumptive diagnosis of viral infection/lymphadenitis. She later developed weakness of her left arm and was diagnosed with a B-cell lymphoblastic leukemia/lymphoma causing spinal cord compression.ConclusionThis case highlights the importance of continued comprehensive and meticulous physical examination in patients with repeat ED visits, as well as the value of detailed discharge instructions in mitigating diagnostic delays in these patients.
Highlights
Malignancy is a rare cause of acquired torticollis in children, and spinal cord involvement from hematolymphoid malignancies is unusual
When additional evaluation would be helpful, it is often hindered by concerns over radiation exposure in pediatric patients, limited availability of magnetic resonance imaging (MRI) capabilities, and the need for sedation to obtain high-quality images in some pediatric patients.[1,2]
The author presents a case of a patient with painless atraumatic torticollis without associated neurologic abnormalities evaluated in the emergency department (ED) who was later diagnosed with B-cell lymphoblastic leukemia/lymphoma with cervical cord compression
Summary
Malignancy is a rare cause of acquired torticollis in children, and spinal cord involvement from hematolymphoid malignancies is unusual. Case Report: The author describes a case of isolated torticollis in a 2-year-old evaluated multiple times in the emergency department (ED) and outpatient settings. For her first three presentations, the patient had no associated neurologic abnormalities. She was discharged with return precautions and a presumptive diagnosis of viral infection/lymphadenitis. She later developed weakness of her left arm and was diagnosed with a B-cell lymphoblastic leukemia/lymphoma causing spinal cord compression
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