Pediatric malignancies presenting as a possible infectious disease.

Area of Science:

• Pediatric Oncology
• Infectious Diseases
• Diagnostic Challenges

Background:

• Clinical, laboratory, and radiological features of malignancy can mimic infection in children.
• Differentiating between infection and malignancy is crucial for accurate diagnosis and treatment.

Purpose of the Study:

• To identify findings in children initially suspected of having an infectious disease but ultimately diagnosed with malignancy.
• To evaluate the overlap in presentation between pediatric infections and malignancies.

Main Methods:

• Retrospective review of patients diagnosed with malignancy at the Northern Alberta Children's Cancer Program (NACCP) from 1993-2003.
• Analysis of patients referred to infectious diseases consult service prior to malignancy diagnosis.

Main Results:

• Infectious diseases consultation was requested for 21 of 561 pediatric malignancy patients before diagnosis.
• Common reasons for consultation included suspected musculoskeletal infection (N=9); 52% had splenomegaly, 48% had elevated LDH.
• Only 2 patients experienced diagnostic delays due to suspected infection.

Conclusions:

• Malignancy is not commonly misdiagnosed as infection in children, leading to treatment delays.
• Pediatric infectious diseases physicians should consider malignancy in differential diagnoses for patients with fever, bone pain, splenomegaly, or abnormal blood counts.
• Hepatomegaly and elevated lactate dehydrogenase (LDH) are additional indicators of potential malignancy.