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

Clinical Practice and Cases in Emergency Medicine
Marina Boushra

Abstract

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. 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. 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.

References

Apr 18, 2009·Anesthesia and Analgesia·Ruth E WachtelAngella J Dow
Aug 21, 2013·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Alicja Fąfara-LeśKrzysztof Kobylarz
Nov 8, 2013·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Hüseyin PerAli Kurtsoy
Jun 6, 2015·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Abdulfettah TumturkHuseyin Per
Dec 23, 2017·The British Journal of Radiology·Orly OhanaEyal Klang
Dec 7, 2019·Pediatric Radiology·Daniel Jack FrushLynn Ansley Fordham

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Methods Mentioned

BETA
sedation
biopsy
flow cytometry

Software Mentioned

CPC
EM

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