Congenital neuroblastoma mimicking early onset sepsis.
A newborn girl presented with symptoms of severe early onset sepsis but also with systemic hypertension (SH) at age 3 h. Plasma catecholamine (CAT) levels were extremely elevated, reflecting increased release of CAT from a congenital neuroblastoma (NB). Clinical symptoms at time of admission were: prolonged capillary refill (5 s), tachycardia, tachydyspnoea, metabolic acidosis (pH 7.17, lactate 11.8 mmol/l), fever (38.4 degrees C) and SH: 90/50/65 mmHg (systolic/diastolic/mean). The infant experienced organ failure (lung, heart, liver). A retroperitoneal dumbbell tumour was detected. Plasma CAT levels at age 15 h were: noradrenaline 219 nmol/l; adrenaline 13 nmol/l; and dopamine 65.3 nmol/l. SH responded to intermittent alpha-adrenergic blockage. CAT-related symptoms ceased within 1 week. The intraspinal NB was surgically removed when cord compression became symptomatic. The neurological and developmental state is normal at age 17 months. The abdominal NB regressed spontaneously.


CONCLUSIONS
A neuroblastoma should be considered in newborn infants presenting with a shock-like condition together with systemic hypertension.
Lindner
W
W
Department of Paediatrics, University of Ulm, Prittwitzstrasse 43, 89070 Ulm, Germany. wolfgang.lindner@medizin.uni-ulm.de
Behnisch
W
W
Kunz
U
U
Debatin
K M
KM
Pohlandt
F
F
D001784:Blood Gas Analysis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D009447:Neuroblastoma / Q000151:congenital / Q000175:diagnosis* / Q000601:surgery; D010547:Persistent Fetal Circulation Syndrome / Q000175:diagnosis* / Q000628:therapy; D013902:Radiography, Thoracic; D012121:Respiration, Artificial; D012186:Retroperitoneal Neoplasms / Q000151:congenital / Q000175:diagnosis* / Q000601:surgery; D018805:Sepsis / Q000175:diagnosis*; D012720:Severity of Illness Index; D016896:Treatment Outcome