A Case Report of B-cell Lymphoblastic Leukemia/Lymphoma Presenting as Isolated Torticollis in a 2-year-old Female

Abstract

Introduction: Malignancy 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 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. Conclusion: This 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.

Pediatric torticollis: clinical report and predictors of urgency of 1409 cases

“…In a recent systematic review of 45 articles, 37 out of the 95 included patients (39%) had torticollis as the first and only presenting symptom of a brain tumor [6]. Numerous case reports in the literature describe other unusual causes of pediatric torticollis [3,[7][8][9][10][11][12][13][14][15][16]. Because of these conflicting and sparse data, a very recent review [17] and best practice guideline [18] suggest that there is still ample room for research.…”