{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:10:23Z","timestamp":1756379423234,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,5,8]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>New diagnoses of leukaemia and other malignancies are recently being made in paediatric patients with COVID-19. The rates of mortality and morbidity in some of these children are expected to be higher. In new cases, concurrent diagnosis can be difficult because multisystemic inflammatory syndrome (MIS-C) and malignancies have similar clinical presentations. We present the case of a preteenage child where the diagnosis of leukaemia was complicated and delayed by a multisystem involvement and an inconclusive bone marrow study. Clinical teams managing children with COVID-19 and MIS-C should suspect leukaemia and other malignancies when the clinical course is complicated and bone marrow suppression is persistent. Prompt diagnosis will allow start of treatment on time, minimising complications.<\/jats:p>","DOI":"10.1136\/bcr-2021-248478","type":"journal-article","created":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T07:41:14Z","timestamp":1653291674000},"page":"e248478","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Difficult acute lymphoblastic leukaemia diagnosis in a paediatric patient with mixed presentation of COVID-19 acute respiratory failure and multisystemic inflammatory syndrome"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6141-6622","authenticated-orcid":false,"given":"Jes\u00fas Angel","family":"Dom\u00ednguez-Rojas","sequence":"first","affiliation":[{"name":"Pediatric Department, National Hospital Edgardo Rebagliati Martins, Lima, Peru"},{"name":"Critical Pediatrics Department, Instituto Nacional de Salud del Ni\u00f1o, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ninoska","family":"Rojas-Soto","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Hospital Edgardo Rebagliati Martins, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4892-5032","authenticated-orcid":false,"given":"Pablo","family":"V\u00e1squez-Hoyos","sequence":"additional","affiliation":[{"name":"Pediatria, Universidad Nacional de Colombia, Bogota, Colombia"},{"name":"Pediatria, Fundacion Universitaria de Ciencias de la Salud, Bogota, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5349-5260","authenticated-orcid":false,"given":"Alvaro J","family":"Coronado Munoz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"2025082803363886000_15.5.e248478.1","unstructured":"Vijenthira A , Gong IY , Fox TA , et al . Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients."},{"key":"2025082803363886000_15.5.e248478.2","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.29005","article-title":"Clinical presentations and outcomes of children with cancer and COVID-19: a systematic review","volume":"68","author":"Meena","year":"2021","journal-title":"Pediatr Blood Cancer"},{"key":"2025082803363886000_15.5.e248478.3","unstructured":"COVID-19 and childhood cancer registry \u2013 St. Jude global. Available: https:\/\/global.stjude.org\/en-us\/global- covid-19-observatory-and-resource-center-for-childhood-cancer\/registry.html"},{"key":"2025082803363886000_15.5.e248478.4","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/S2352-4642(21)00031-6","article-title":"Global effect of the COVID-19 pandemic on paediatric cancer care: a cross-sectional study","volume":"5","author":"Graetz","year":"2021","journal-title":"Lancet Child Adolesc Health"},{"key":"2025082803363886000_15.5.e248478.5","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/S1470-2045(20)30619-7","article-title":"The effect of clinical decision making for initiation of systemic anticancer treatments in response to the COVID-19 pandemic in England: a retrospective analysis","volume":"22","author":"Clark","year":"2021","journal-title":"Lancet Oncol"},{"key":"2025082803363886000_15.5.e248478.6","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6932e2"},{"key":"2025082803363886000_15.5.e248478.7","doi-asserted-by":"crossref","first-page":"e1177","DOI":"10.1097\/MPH.0000000000002064","article-title":"Pediatric acute B-cell lymphoblastic leukemia developing following recent SARS-CoV-2 infection","volume":"43","author":"Leclercq","year":"2021","journal-title":"J Pediatr Hematol Oncol"},{"key":"2025082803363886000_15.5.e248478.8","doi-asserted-by":"crossref","first-page":"e1241","DOI":"10.1097\/MPH.0000000000002037","article-title":"Childhood B-Cell Acute Lymphoblastic Leukemia Following SARS CoV-2 Infection: A Potential Second \u201cHit\u201d in Leukemogenesis","volume":"43","author":"Persaud","year":"2021","journal-title":"J Pediatr Hematol Oncol"},{"key":"2025082803363886000_15.5.e248478.9","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.28745","article-title":"Hematological manifestations of SARS-CoV-2 in children","volume":"67","author":"Kosmeri","year":"2020","journal-title":"Pediatr Blood Cancer"},{"key":"2025082803363886000_15.5.e248478.10","doi-asserted-by":"crossref","DOI":"10.5867\/medwave.2021.01.8107","article-title":"[Cross-sectional study of the clinical characteristics and outcomes of children hospitalized with COVID-19 in Lima, Peru]","volume":"21","author":"Dom\u00ednguez Rojas","year":"2021","journal-title":"Medwave"},{"key":"2025082803363886000_15.5.e248478.11","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.28610","article-title":"COVID-19 in pediatric cancer patients in a resource-limited setting: national data from Peru","volume":"68","author":"Montoya","year":"2021","journal-title":"Pediatr Blood Cancer"},{"key":"2025082803363886000_15.5.e248478.12","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.28843","article-title":"Characterization of COVID-19 disease in pediatric oncology patients: the new York-New Jersey regional experience","volume":"68","author":"Madhusoodhan","year":"2021","journal-title":"Pediatr Blood Cancer"},{"key":"2025082803363886000_15.5.e248478.13","doi-asserted-by":"crossref","unstructured":"de Rojas T , P\u00e9rez\u2010Mart\u00ednez A , Cela E , et al . COVID\u201019 infection in children and adolescents with cancer in Madrid. Pediatr Blood Cancer 2020;67.doi:10.1002\/pbc.28397","DOI":"10.1002\/pbc.28397"},{"key":"2025082803363886000_15.5.e248478.14","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.pediatrneurol.2015.03.006","article-title":"Acute central nervous system complications in pediatric acute lymphoblastic leukemia","volume":"53","author":"Baytan","year":"2015","journal-title":"Pediatr Neurol"},{"key":"2025082803363886000_15.5.e248478.15","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.21037\/tp-20-445","article-title":"MR spectroscopy in pediatric neuroradiology","volume":"10","author":"Liserre","year":"2021","journal-title":"Transl Pediatr"},{"key":"2025082803363886000_15.5.e248478.16","doi-asserted-by":"crossref","unstructured":"Boccuzzi E , Ferro V , Cinicola B . Uncommon presentation of childhood leukemia in emergency department: the usefulness of an early multidisciplinary approach. Pediatr Emerg Care 2018:e412\u20136.doi:10.1097\/PEC.0000000000001694","DOI":"10.1097\/PEC.0000000000001694"},{"key":"2025082803363886000_15.5.e248478.17","first-page":"1","article-title":"High incidence of stroke and mortality in pediatric critical care patients with COVID-19 in Peru","author":"Coronado Munoz","year":"2021","journal-title":"Pediatr Res"},{"key":"2025082803363886000_15.5.e248478.18","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2021.0504"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-248478","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:36:52Z","timestamp":1756377412000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-248478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":18,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,20]]},"published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1136\/bcr-2021-248478"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-248478","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2022,5]]}}}