Articles

The Importance of Diagnostic Vigilance Amid Cultural Barriers in Pediatric Oncology: A Case of Atypical B-ALL

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Pediatric cancers have the ability to spread rapidly, however, they also respond well to chemotherapy, and can have incredible success rates when diagnosis and intervention are implemented early. This case report describes an unusual presentation of B-ALL in a patient whose treatment was initially delayed due to barriers of cultural origin. The child initially presented with high fevers and vomiting, with mild abdominal distention and tenderness. With concern for sepsis or the need for surgical intervention, the pediatrician urged the family to proceed to a tertiary care center for further workup. The family felt these processes were unnecessary and felt that he would recover at home with over-the-counter medications. As the boy remained ill, emergency care was sought, and further investigations revealed a diagnosis of B-cell acute lymphoblastic leukemia. With this case report, we examine the importance of diagnostic vigilance amongst physicians to ensure a prompt and accurate diagnosis, while remaining mindful of cultural factors that may complicate clinical assessment and compliance.

Failure to Thrive in an 18-Month-Old Female Infant with Rickets: A Case Report

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: Undetected vitamin D deficiency can lead to severe complications such as Rickets in infants. This case report describes an unusual case of an 18-month-old female infant who presented with failure to thrive early in infancy and was later diagnosed with Rickets. The infant initially presented with failure to thrive, labs were ordered, and findings demonstrated low 25-hydroxyvitamin D and elevated alkaline phosphatase. Radiographic imaging of the knee was ordered and showed transverse sclerotic metaphyseal bands involving the distal femoral metaphysis and portion of the proximal tibial metaphysis, findings consistent with untreated rickets. A thorough investigation was conducted to determine the primary cause of the vitamin D deficiency, identifying the primary cause as nutritional deficiency. Per endocrinology, the patient was started on cholecalciferol 800 IU daily with dietary changes. This case emphasizes the importance of checking vitamin D levels in all pediatric patients who present with failure to thrive.