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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2018; 39(04): 551
DOI: 10.4103/ijmpo.ijmpo_64_17
Letters to Editor

Mixed Malarial Infection with Pancytopenia in a Child with Acute Lymphoblastic Leukemia: An Unusual Presentation

Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
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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.



Publication History

Article published online:
17 June 2021

© 2018. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 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
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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
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  • 3 Basu S, Sahi PK. Malaria: An update. Indian J Pediatr 2017; 84: 521-8
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