title: A rapid increase in the normal white cell counts without blasts as the initial presentation of T-cell acute lymphoblastic leukaemia.
abstract: A 5-year-old girl with multiple enlarged cervical lymph nodes consistent with Epstein-Barr virus infection showed a rapid increase in the white blood cell counts (myeloid cells and lymphocytes) without blasts over a week period. Bone marrow evaluation performed after a week's observation unexpectedly showed replacement of the marrow with T lymphoblasts. A presentation of T-cell acute lymphoblastic leukaemia (T-ALL) in this fashion is very unusual. We postulate that the T-lymphoblasts may have been secreting granulocyte colony stimulating factor like substance. We are unable to find a similar case report in the literature, and thus we wish to report this case. The patient has been treated with Children's Oncology Group T-ALL protocol, and has been in continuous remission.
authors.affiliation: Department of Pediatric Hematology/Oncology, Hurley Children's Hospital, Flint, Michigan, USA. sinoue1@hurleymc.com
authors.forename: Susumu
authors.initials: S
authors.lastname: Inoue
authors.forename: Jitendra
authors.initials: J
authors.lastname: Sah
authors.forename: Nkechi
authors.initials: N
authors.lastname: Onwuzurike
mesh_terms: D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood* / Q000175:diagnosis