Abstract
BackgroundThe clinical, laboratory, and radiological features of malignancy can overlap with those of infection. The purpose of this study was to determine the findings in children who were initially thought to have an infectious disease but ultimately proved to have a malignancy.MethodsThe database of patients diagnosed with a malignancy in the Northern Alberta Children's Cancer Program (NACCP) January 1, 1993 to December 31, 2003 was merged with the database of inpatients referred to the infectious diseases service at the Stollery Children's Hospital and charts were reviewed on all patients referred to the infectious diseases consult service prior to the diagnosis of malignancy.ResultsAn infectious diseases consultation for diagnosis was requested in 21 of 561 patients prior to the confirmation of malignancy, and 3 of these 21 patients had both infection and malignancy (leukemia (N = 13), lymphoma (N = 3), rhabdomyosarcoma (N = 1), Langerhan's cell histiocytosis (N = 1), fibrous histicocytosis (N = 1), ependymoma (N = 1), and neuroblastoma (N = 1). The most common reason for infectious diseases consultation was suspected muskuloskeletal infection (N = 9). A palpable or radiographically enlarged spleen was noted in 11 patients (52%). All but 2 patients had abnormal hematologic parameters while an elevated lactate dehydrogenase (LDH) occurred in 10 patients (48%). Delay of diagnosis because of investigation or therapy for an infectious disease occurred in only 2 patients.ConclusionIt is not common for treatment of pediatric malignancies to be delayed because infection is thought to be the primary diagnosis. However, pediatric infectious diseases physicians should consider malignancy in the differential diagnosis when they see patients with fever and bone pain, unexplained splenomegaly or abnormal complete blood cell counts. Other clues may include hepatomegaly or elevated LDH.
Highlights
The clinical, laboratory, and radiological features of malignancy can overlap with those of infection
We hypothesized that if children were misdiagnosed with an infection initially, there would be a delay in cancer therapy
The database of patients diagnosed with a malignancy in the Northern Alberta Children's Cancer Program (NACCP) January 1, 1993 to December 31, 2003 was matched with the database of inpatients referred to the infectious diseases service at the Stollery Children's Hospital within six months prior to diagnosis
Summary
The clinical, laboratory, and radiological features of malignancy can overlap with those of infection. The purpose of this study was to determine the findings in children who were initially thought to have an infectious disease but proved to have a malignancy. [2] there can be delays in the diagnosis because the signs and symptoms of malignancy may be initially misdiagnosed as infection. There have been no previous systematic assessments of the clinical findings, laboratory findings and radiological (page number not for citation purposes). BMC Infectious Diseases 2007, 7:44 http://www.biomedcentral.com/1471-2334/7/44 findings of children initially thought to have an infection who were diagnosed with a malignancy. We hypothesized that if children were misdiagnosed with an infection initially, there would be a delay in cancer therapy. We hypothesized that if these patients had consistent findings, this information could be used to help pediatric infectious diseases physicians know when to consider malignancy in the differential diagnosis
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