Sinusitis as Initial Presentation of Acute Lymphoblastic Leukemia - Case Report

Acute leukemia is a potentially curable hematopoietic malignancy characterized by an absolute increase in total body immature leukocytes. Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children. Here, we present a case of sinusitis as initial presentation of acute lymphoblastic leukemia. An 8-year-old Taiwanese boy with right facial swelling for two weeks was managed conservatively under the impression of acute sinusitis. However, his right facial swelling persisted despite surgical intervention and intravenous antibiotics treatment. Followed-up lab data showed hyperleukocytosis (white blood cell count: 30.99*10^3/uL, blast form 50%, neutrophils 30%, lymphocyte 14%). Third weeks after admission, acute lymphoblastic leukemia was then diagnosed. This case illustrated rare, aggressive diseases such as acute lymphoblastic leukemia can masquerade as simple subacute sinusitis without typical signs like fever, pallor, bleeding tendency or fatigue.

關鍵字

Acute lymphoblastic leukemia ； sinusitis ； facial swelling

並列摘要

兒童急性淋巴性白血病是兒童最常見的惡性疾病，約佔兒童癌症的25%左右，其中B細胞急性淋巴白血病約佔85%，T細胞急性淋巴白血病約佔15%。兒童急性淋巴白血病起因於正常的骨髓細胞被芽細胞所取代，因此可能會以貧血、血小板低下造成的出血點、骨頭痛、正常白血球低下造成持續性發燒等等來表現。本院1名8歲男性兒童，主訴右臉腫脹約2週，理學檢查時右側下鼻甲腫脹、右鼻道完全阻塞。電腦斷層顯示右側鼻竇有積液和骨質增厚，伴有右頰軟組織腫脹，懷疑右側上頷竇發炎相關。住院期間，該兒童進行多次鼻竇內視鏡手術併放置引流管灌洗，但右頰腫脹並無改善。同時儘管持續給予抗生素治療，白血球指數仍持續上升。第3週，血液檢查報告顯示異常上升的白血球30.99*10^3/uL，芽細胞50%，乳酸脫氫酶368 IU/L，會診小兒血液腫瘤科後，骨髓穿刺檢查確診為急性T細胞淋巴性白血病。我們在此提出這個少見案例，提醒毫無壓痛的臉部腫脹，有可能是兒童急性淋巴白血病的初始表現，易被誤認為是鼻竇炎，需持續追蹤相關血液檢查，方能早期診斷。

並列關鍵字

Acute lymphoblastic leukemia ； sinusitis ； facial swelling（急性淋巴球白血病；鼻竇炎；臉部腫脹）

主題瀏覽