Rashid Mahmood, Waqar Hussain, Sajid Maqbool.
Acute congenital myeloid Leukemia.
Pak Paed J Jan ;19(2):83-4.

A three months old male child presented with illness starting from the 15th day of life, when he had the first episode of high grade fever, cough and respiratory distress. This lasted for 8 clays, and was managed with antibiotics. He got sick again with the same complaints once week later, and then had similar episodes repeatedly and had to be hospitalized twice during the past two months. There was no cyanosis, choking, or skin lesions. Birth history was normal with normal antenatal anal post natal events. On examination he was a sick looking febrile child, with no obvious dysmorphism no lymphadenopathy or cyanosis. He had bilateral corneal opacities, while weight and height were appropriate for age. His abdomen was protuberant and soft, liver being palpable by about 4 cm in the midclavicular line, with its upper border in 5th intercostal space, round sharp margins, firm consistency and smooth surface. Spleen was palpable by about 1.5 cm, with sharp round margins and firm consistency. On admission he had signs of respiratory distress and bilateral coarse crepitations on auscultation. There was nothing else positive in the examination. His blood examination revealed Hb 7.3 gm/dl, TLC 16x10e9 /I, with 6% polys and 11% lymphos and Platelet count 27,000. Peripheral blood picture was normocytic normochromic, CSF examination was negative, and all cultures including blood, urine and CSF were negative. A radiological survey was non revealing. Bone marrow aspirate showed hypoplastic erythropoiesis anal few maturing forms and hyperplastic myelopoiesis with all stages of maturation. Blast cells were more than 40% of total cells stained intensely with Sudan Black B (SBB), and occasional ones showed staining of granules (non-specific estrases). Diagnosis was of acute mycloid leukemia-M 2.

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