What's hidden in the blood - A case of pancytopenia
Bárbara Marques1,2, Sofia Moeda1, Marta Contreiras1, Ana Lacerda3, Paulo Oom1.
1Department of Pediatrics, Hospital Beatriz Ângelo, Loures, Portugal,
2Pediatric Service, Department of Pediatrics, Hospital Santa Maria (CHLN), Lisbon Academic Medical Center, Portugal,
3Department of Child and Adolescent Oncology, Pediatric Service, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal.
A three-year-old girl presented to the emergency department with fever, cough and nasal congestion. Physical examination revealed pallor and splenomegaly. Blood analysis showed pancytopenia. She recovered quickly and uneventfully and was discharged with a diagnosis of pancytopenia caused by an unidentified virus. On outpatient follow-up, the blood counts further normalized. However, five months later, in the context of de novo facial palsy, limping and bone pain, a diagnosis of acute lymphoblastic leukemia (ALL) was made. With this case, we aim to emphasize the importance of maintaining a close follow-up of patients with pancytopenia, due to the risk of recurrence or a pre-malignant condition.

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