Gum hypertrophy in acute myeloid leukemia: an important clinical finding not to be missed

Acute myeloid leukaemia (AML) is characterized by disordered differentiation and proliferation of abnormal hematopoietic stem cells. AML usually presents with symptoms of anemia like pallor and fatigue, recurrent infections, petechiae, and mucosal bleeds. Extramedullary infiltration of leukemic cells is a common finding like proptosis or myeloid sarcoma. The occurrence of gingival hypertrophy in the pediatric age group is uncommon and usually due to inflammation followed by prolonged use of certain drugs like cyclosporin or phenytoin. Gingival infiltration in AML is rare in children, usually associated with subtypes M4/M5 (FAB classification). This case report highlights the importance of considering AML as an important differential diagnosis in cases of gum hypertrophy, as being a less common cause, it is often overlooked. Timely diagnosis and prompt treatment can be lifesaving. Here, we report two cases who presented with gum hypertrophy.

Malaria: a masquerader of cytopenias in leukemia

In developing countries where the prevalence of malaria and cancer are high it can be expected to occur together. 6-year-old male child, a known case of B cell acute lymphoblastic leukemia, on maintenance phase of chemotherapy presented to us with fever. His initial investigations showed no identifiable focus or significant abnormalities. He continued to have high grade fever spikes in spite of stepping up antibiotics. A week after admission he was found to have cytopenias and mild splenomegaly. Peripheral smear and bone marrow aspiration study showed enlarged RBCs infested by Plasmodium vivax. We report this case to make the clinicians aware that malaria can be cause of fever in patients on cancer treatment.

Look into their eyes and save their vision: role of primary health care provider in early diagnosis of retinoblastoma

Childhood cancer is not amenable to preventive or screening strategies. The most effective strategy to reduce the cancer burden and improve outcomes, is to focus on early, correct diagnosis followed by evidence-based therapy. When diagnosed early, they are responsive to appropriate therapy and increases survival rates, thereby reducing the need for intensive treatment and reduces the expenditure per child. Retinoblastoma is the most common intra ocular malignancy and is one of the most curable cancers in children. If diagnosed early and treated optimally, not only they are completely cured but a vast majority can have ocular salvage and retain vision. Lack of awareness among general population, diagnostic delays, delays in referral to proper treatment centre, compounded by socio economic factors attributes to the poor outcome in such children. We report a case of 2 years 10 months old girl child whose initial presentation of leukocoria was missed and later presented with advanced retinoblastoma with CNS metastasis.