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Juvenile myelomonocytic leukemia presenting in an infant with a subdural hematoma

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Abstract

Background

Juvenile myelomonocytic leukemia (JMML) is a rare childhood hematopoietic disorder typically presenting with hepatosplenomegaly, lymphadenopathy, pallor, fever, and cutaneous findings. The authors report the first case, to our knowledge, of JMML presenting in a pediatric patient with a subdural hematoma.

Case description

A 7-month old male with recurrent respiratory infections and a low-grade fever presented with a full fontanelle and an increasing head circumference and was found to have chronic bilateral subdural collections. Abusive head trauma, infectious, and coagulopathy workups were unremarkable, and the patient underwent bilateral burr holes for evacuation of the subdural collections. The postoperative course was complicated by the development of thrombocytopenia, anemia, and an acute subdural hemorrhage which required evacuation. Cytologic analysis of the subdural fluid demonstrated atypical cells, which prompted flow cytometric analysis, a bone marrow biopsy, and ultimately a diagnosis of JMML. Following chemotherapy, the patient’s counts improved, and he subsequently underwent a hematopoietic stem cell transplant.

Conclusion

Subdural collections may rarely represent the first presenting sign of hematologic malignancies. In patients with a history of recurrent infections and a negative workup for abusive head trauma, clinicians should include neoplastic etiologies in the differential for chronic subdural collections and have a low threshold for fluid analysis.

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Authors and Affiliations

  1. University of Connecticut School of Medicine, Farmington, CT, USA

    William A. Lambert

  2. Special Hematology Laboratory, Department of Pathology & Laboratory Medicine, Hartford Hospital, Hartford, CT, USA

    Joseph A. DiGiuseppe

  3. Division of Hematology-Oncology, Connecticut Children’s, Hartford, CT, USA

    Tatiana Lara-Ospina

  4. Division of Neurosurgery, Connecticut Children’s, Hartford, CT, USA

    Markus J. Bookland, Jonathan E. Martin & David S. Hersh

  5. Department of Surgery, UConn School of Medicine, Farmington, CT, USA

    Markus J. Bookland, Jonathan E. Martin & David S. Hersh

  6. Department of Pediatrics, UConn School of Medicine, Farmington, CT, USA

    Markus J. Bookland & David S. Hersh

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  1. William A. Lambert
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Correspondence to David S. Hersh.

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Lambert, W.A., DiGiuseppe, J.A., Lara-Ospina, T. et al. Juvenile myelomonocytic leukemia presenting in an infant with a subdural hematoma. Childs Nerv Syst 37, 2075–2079 (2021). https://doi.org/10.1007/s00381-020-05013-7

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  • DOI: https://doi.org/10.1007/s00381-020-05013-7

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