Morbid iatrogenic epistaxis in a child with undiagnosed hematological malignancy: a case report

Epistaxis is a common pediatric emergency, usually benign, and self-limiting. However, it may indicate serious underlying disease, particularly hematologic malignancy. In resource-limited settings, delayed diagnosis and inadequate expertise can worsen outcomes, and inappropriate nasal packing may aggravate bleeding in children with unrecognized coagulopathies. This case involves a 6-year-old girl with five days of spontaneous intermittent epistaxis, initially managed with anterior nasal packing that led to worsening hemorrhage and referral. Examination revealed extensive iatrogenic mucosal injuries, while laboratory investigations showed severe anemia, thrombocytopenia, and leukocytosis. She was diagnosed with B-cell acute lymphoblastic leukemia and later died from uncontrolled gastrointestinal and nasal bleeding despite treatment. The case highlights the need for prompt evaluation of recurrent or severe pediatric epistaxis for potential hematologic malignancy and illustrates the risks posed by unsafe nasal packing and limited diagnostic resources in low-resource healthcare settings.