T-cell Acute Lymphoblastic Leukemia in an Infant: A Case Report and Review of Literature

Area of Science:

• Pediatric Hematology Oncology
• Immunophenotyping and Leukemia Diagnostics

Background:

• Infant leukemia is rare and aggressive, often presenting with atypical clinical and laboratory features.
• Prompt diagnosis and treatment are critical for improving outcomes in pediatric leukemia.
• B-cell acute lymphoblastic leukemia (ALL) is the predominant phenotype in infants.

Observation:

• A 10-month-old infant presented with a month-long history of fever and restlessness.
• Initial laboratory findings included bicytopenia, borderline leukocytosis, a leucoerythroblastic picture, and reactive lymphocytes.
• Despite antibiotic treatment for suspected infection, symptoms persisted, prompting further investigation.

Findings:

• Bone marrow aspirate analysis using flow cytometry confirmed T-cell acute lymphoblastic leukemia (T-ALL).
• This diagnosis is unusual as infant ALL typically exhibits a B-cell phenotype.
• T-cell ALL is exceptionally rare in infants.

Implications:

• This case underscores the importance of maintaining a high index of suspicion for leukemia in infants, even with atypical presentations.
• Recognition of rare phenotypes like T-ALL in infants is essential for timely and appropriate management.
• Increased awareness can improve diagnostic approaches and treatment strategies for infant leukemia, irrespective of immunophenotype or age.