Acute Lymphoblastic Leukaemia Presenting as Pleural and Pericardial Effusions: A Case Report

Abstract

The most common presentations of Acute Lymphoblastic Leukaemia (ALL) are related to intramedullary symptoms, but extramedullary symptoms may also occur. ALL presenting as pleural effusion is very uncommon, and pericardial effusions are rarer. There is a need for a high index of suspicion in the presence of unusual symptoms to prevent delayed diagnosis and poorer outcomes. We report on the case of a nine-year old boy who presented with fever and cough of three weeks and had haemorrhagic bilateral pleural and pericardial effusions. Laboratory screenings for Lassa fever, tuberculosis, and sepsis were negative. Pericardiocentesis and closed thoracotomy continued to drain. Several full blood counts (CBC) at presentation and during admission were normal, but a repeat on day 23 of admission showed marked leucocytosis. ALL was confirmed with bone marrow aspirate cytology. Effusions resolved when chemotherapy was commenced. ALL can masquerade with features of common conditions, resulting in delayed diagnosis and poorer patient outcomes. A high index of suspicion is necessary when unusual findings are observed.