[Hemiparesis in acute lymphoblastic leukemia]. / Hemiparese bei akuter lymphoblastischer Leukämie.

The case of an adolescent female patient with acute lymphoblastic leukemia and stroke-like hemiparesis demonstrates a typical manifestation of methotrexate-induced acute encephalopathy. This rare entity occurs both in children and adults and can result from intrathecal as well as high dose intravenous administration of methotrexate. Diagnosis can confidently be made using cerebral MRI including diffusion-weighted imaging (DWI), so that patients can be informed about the favorable prognosis.

[Acute lymphoblastic leukemia presenting without peripheral blasts but with osteolysis and hypercalcemia in an adolescent. Atypical but not rare]. / Manifestation einer akuten lymphoblastischen Leukämie mit Osteolyse, Hyperkalzämie und unauffälligem Blutbild bei einer Jugendlichen. Untypisch aber nicht selten.

Joint pain is one of the major symptoms in early leukemia. We report on a 16-year-old girl who presented with groin pain and an osteolytic bone lesion. Acute lymphoblastic leukemia was diagnosed, but the laboratory workup and radiologic imaging revealed atypical results. Particularly in early precursor B-cell acute lymphoblastic leukemia, comparable initial symptoms and signs have been reported in adolescents; therefore, we recommend performing a bone marrow aspiration early on in cases of suspected osteolytic bone lesions.

Myocardial iron overload in transfusion-dependent pediatric patients with acute leukemia.

For patients who regularly receive blood transfusions, cardiac failure is the major cause of death. This is most alarming because it progresses rapidly and is difficult to manage. We present three pediatric patients with acute leukemia whose therapy-induced anemia was treated with different amounts of red blood cell concentrates (RCC). In all patients, a liver iron overload was measured by super-conducting interference device (SQUID) biosusceptometry and magnetic resonance imaging (MRI). MRI is a rapid, noninvasive, and widely available method of determining early myocardial iron overload caused by multiple blood transfusion due to anemia during polychemotherapy.

Neonatal mastocytosis with pachydermic bullous skin without c-Kit 816 mutation.

BACKGROUND: Bullous mastocytosis is an unusual variant of mast cell disease with widespread bullae as the main cutaneous feature induced by mast cell proteases that cause dermoepidermal separation. CASE REPORT: A rare case of diffuse cutaneous bullous mastocytosis with pachydermia and unusually extensive skin folding is described in a 3-week-old girl. The diagnosis was confirmed by immunohistochemistry with Giemsa stain, the naphthol ASD chloroacetate esterase reaction and elevated blood levels for tryptase, histamine in serum and histamine and 1.4-methylimidazol acetic acid in the 24-hour urine. Blood cell count was normal, as were thrombocytosis and leukocytosis. FACS analysis of the bone marrow aspiration material showed 1% mast cells. No c-Kit 816 [Asp-->Val] somatic mutation was found. Systemic involvement of other organs was excluded. DISCUSSION: The prognosis of c-Kit-negative diffuse bullous mastocytosis is not known. Regular blood controls are mandatory, and screening for germ cell ovarian cancer and bone marrow controls should be performed as well.