Sudden and unexpected infant death due to occult lymphoblastic leukaemia

Area of Science:

• Pediatric Pathology
• Hematology-Oncology
• Sudden Infant Death Syndrome (SIDS)

Background:

• Unexpected infant death presents a diagnostic challenge, often necessitating comprehensive post-mortem examinations.
• Leukemia, particularly in infants, can manifest with subtle or absent preceding symptoms, complicating early diagnosis.
• Pre-B cell lymphoblastic leukemia is a rare pediatric malignancy.

Purpose of the Study:

• To report an extremely rare case of unexpected infant death attributed to widespread lymphoblastic leukemia.
• To emphasize the critical role of complete autopsy in identifying the cause of sudden, unexplained infant mortality.
• To highlight the potential for severe systemic disease to present with minimal or no overt clinical signs in infants.

Main Methods:

• Post-mortem examination (autopsy) of a 16-week-old infant found deceased.
• Histopathological analysis of multiple organs to identify pathological infiltration.
• Review of home video footage from the day prior to death for clinical correlation.

Main Results:

• Autopsy revealed widespread organ infiltration by pre-B cell lymphoblastic leukemia.
• Death was primarily attributed to extensive leukemic cell infiltration of the myocardium.
• No intracranial hemorrhage was observed; home video showed a seemingly healthy infant the day before death.

Conclusions:

• This case underscores lymphoblastic leukemia as a rare but devastating cause of unexpected infant death.
• Full autopsy examination is crucial for diagnosing such rare conditions in cases of sudden infant death.
• Infants can exhibit minimal or no symptoms despite severe, life-threatening systemic disease, complicating clinical recognition.