Meralgia Paresthetica as a Presentation of Acute Appendicitis in a Girl With Acute Lymphoblastic Leukemia

Nishimura, Miho; Kodama, Yuichi; Fukano, Reiji; Okamura, Jun; Ogaki, Kippei; Sakaguchi, Yoshihisa; Migita, Masahiro; Inagaki, Jiro

doi:10.1097/mph.0000000000000189

Cited by 4 publications

(2 citation statements)

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“…It is well-known that neutropenic patients with intra-abdominal infections are likely to present with a blunted clinical presentation and fewer symptoms of a lesser magnitude due to a decreased immune response [ 16 , 17 ]. These atypical clinical presentations may result in a delay of diagnosis, which increases the risk of serious complications including perforation, abscess formation, peritonitis, sepsis, and death, particularly if the hematologic disorder has not been yet diagnosed or recognized, such as in our patient [ 8 ]. This case report highlights the importance of histopathological evaluation of surgical specimens to rule out malignancy of all kinds, particularly in the setting of abnormal hematologic studies in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…Appendicitis is the most common abdominal emergency requiring surgery with a lifetime risk of about 7% with peak incidence in the late teens and early twenties [ 1 , 2 ]. Acute appendicitis is a known complication of treatment for hematologic malignancies, with a reported incidence of 0.5% to 4.4%, but involvement of the appendix with leukemic cells is rare [ [3] , [4] , [5] , [6] , [7] , [8] , [9] ]. Even more rare is the identification and diagnosis of ALL as a result of a clinical presentation of acute appendicitis.…”

Section: Introductionmentioning

confidence: 99%

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Unexpected diagnosis of acute lymphoblastic leukemia in a 2-year-old with acute appendicitis – Case report

Marison

Pati

Laferriere

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Appendicitis is an extremely common surgical problem, especially in the pediatric population. However, leukemic infiltration of the appendix is rare and even more so is having acute appendicitis as the initial manifestation. Case presentation The patient is a 2-year-old female with multiple febrile illnesses since birth, who presented to the emergency department with a 3-day history of abdominal pain, fever, and decreased appetite. Ultrasound of her right lower quadrant was consistent with acute appendicitis. A laparoscopic appendectomy was performed successfully without complication. However, pathological examination of the specimen revealed an appendix with partial involvement of B-lymphoblastic lymphoma/leukemia in a background of lymphoid hyperplasia. This prompted referral to a pediatric hematologist/oncologist. Further workup revealed abnormal immature cells on peripheral blood flow cytometry. Bone marrow biopsy confirmed a diagnosis of B-cell acute lymphoblastic leukemia. Clinical discussion Though acute appendicitis is very common and management is well documented, it is rare for pathological examination to uncover leukemia as an underlying etiology and to have acute appendicitis as the initial manifestation of hematologic malignancy. To our knowledge, very few similar events have occurred and been documented in the medical literature. Conclusion Physicians and surgeons should be aware that, though quite rare, leukemic infiltration of the appendix can occur and should be considered in the differential diagnosis of acute appendicitis. Notably, pathologic examination of the appendix may be particularly informative. Diligent follow-up of abnormal pathology is crucial in cases suggestive of underlying hematologic malignancy.

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Section: Discussionmentioning

confidence: 99%