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Indian Journal of Medical and Paediatric Oncology
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LETTERS TO EDITOR
Year : 2018  |  Volume : 39  |  Issue : 4  |  Page : 551  

Mixed malarial infection with pancytopenia in a child with acute lymphoblastic leukemia: An unusual presentation


Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Date of Web Publication15-Nov-2018

Correspondence Address:
Prof Mahmood Dhahir Al-Mendalawi
P.O.Box 55302, Baghdad Post Office, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmpo.ijmpo_64_17

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How to cite this article:
Al-Mendalawi MD. Mixed malarial infection with pancytopenia in a child with acute lymphoblastic leukemia: An unusual presentation. Indian J Med Paediatr Oncol 2018;39:551

How to cite this URL:
Al-Mendalawi MD. Mixed malarial infection with pancytopenia in a child with acute lymphoblastic leukemia: An unusual presentation. Indian J Med Paediatr Oncol [serial online] 2018 [cited 2018 Dec 16];39:551. Available from: http://www.ijmpo.org/text.asp?2018/39/4/551/245500

Sir,

I have read with interest the case report by Ramesh et al. on mixed malarial infection associated with pancytopenia in a child with acute lymphoblastic leukemia (ALL).[1] Two plausible explanations could be addressed to explain that association. The first is that it is an incidental association. The second is that it is possibly an etiological association. It is noteworthy that severe childhood infections can occasionally be accompanied by bone marrow suppression and that it is unusual for infection-induced marrow aplasia to evolve into acute leukemia.[2] I presume that the observed pancytopenia in the case in question was probably the result of malarial parasite acting in rhythm with the failing bone marrow and malarial parasite is possibly one of many factors able of initiating the onset of pre-ALL. Molecular studies are needed to determine the exact mechanism.

Second, India is endemic for malaria with unstable transmission inhibiting the development of immunity and predisposing all age groups to the disease.[3] I presume that the case in question sends an important message to the practicing clinicians in malaria-endemic areas to consider underlying malignancy in malaria patients if pancytopenia is refractory despite eradication of malarial infection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ramesh V, Venkata NM, Sankar J. Mixed malarial infection with pancytopenia in a child with acute lymphoblastic leukemia: An unusual presentation. Indian J Med Paediatr Oncol 2017;38:92.  Back to cited text no. 1
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2.
Rajendran A, Trehan A, Ahluwalia J, Marwaha RK. Severe systemic infection masking underlying childhood leukemia. Indian J Hematol Blood Transfus 2013;29:167-70.  Back to cited text no. 2
    
3.
Basu S, Sahi PK. Malaria: An update. Indian J Pediatr 2017;84:521-8.  Back to cited text no. 3
    




 

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