P0699 / #555: LEUKEMIA IN A 1-MONTH-OLD FEMALE PRESENTING WITH ABDOMINAL DISTENSION AND CONSTIPATION

Abstract

Aims & Objectives: Purpose: Acording to the literature pediatric leukemia is frequently presented in children between 1-10 years (60%) and there are a few cases in infants (less tan 4.7%). This is a case of an infant presenting with hyperleukocytosis, trombocitopenia and anemia who was diagnosed of acute lymphoblastic leukemia. Methods: Case Report: 1-month-old female presented to an outside hospital with abdominal distension, constipation, petechia and melena of 3 weeks of evolution, it was treated with formula change and laxative without improvement. A blood citometry was requested, 330,000 leukocytes and 17,000 platelets were reported. She was transferred to our hospital. Initial vital signs showed: temperature 37.2° C, heart rate 173 bpm, blood pressure 90/60 mmHg, oxygen saturation of 98%. An arterial blood gas showed metabolic acidosis, hypokalemia and hypocalcemia. Chest radiograph was normal. The patient recieved hyperhidratation intravenous fluids, oxygen via nasal canula and platelet transfusion and was admitted to the PICU. Results: Evolution: 24 hours admission: the patient present acute respiratory failure that requires mechanical ventilation, with persistent hypoxemia (pAFi: 63) that was treated with lung protection maneuvers and pronation for 14 hours, the hypoxemia improved after 3 days and ventilatory settings were reduced. 48 hours after admission the patient developed tumoral lysis syndrome (hyperuricemia, hyperphosphatemia and hypocalcemia), continuous renal replacement was started for 16 hours remitting tumoral lysis syndrome. Diagnosis of leukemia was confirmed and dexametasone was started at 5 mgm2scd. Conclusions: Discussion: Acute leukemia in infants is rare and usually this patients have a poor or fatal outcome.