Fulminant Acute Lymphoblastic Leukemia in Sudden Unexpected Pediatric Death

Area of Science:

• Forensic Pathology
• Pediatric Oncology
• Hematology

Background:

• Sudden unexpected death due to neoplastic disease in infancy and childhood (SUDNIC) is a rare but critical cause of pediatric mortality.
• Hematologic malignancies are a significant underlying factor in SUDNIC cases.
• Diagnostic challenges arise from limited clinical history and nonspecific autopsy findings.

Purpose of the Study:

• To report a case of SUDNIC caused by acute lymphoblastic leukemia (ALL).
• To emphasize the importance of recognizing subtle autopsy findings suggestive of leukemia.
• To guide forensic pathologists in suspecting and confirming leukemia in pediatric deaths.

Main Methods:

• Autopsy examination of an 18-month-old child found unresponsive.
• Gross examination revealing bilateral nephromegaly and multiorgan pallor.
• Microscopic examination and immunohistochemical staining (Tdt, CD43) for leukemic infiltration.

Main Results:

• Autopsy showed bilateral enlarged kidneys (nephromegaly) and pale organs, with enlarged lymph nodes.
• Microscopic analysis confirmed leukemic infiltration in kidneys, bone marrow, lymph nodes, and other organs.
• Immunohistochemistry confirmed the diagnosis as acute lymphoblastic leukemia (ALL).

Conclusions:

• Fulminant ALL leading to acute renal failure was the cause of death.
• Hematologic malignancy, specifically ALL, is an important consideration in SUDNIC.
• Nephromegaly and renal pallor on autopsy warrant investigation for leukemia, with flow cytometry recommended for confirmation.