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This case report is pertaining to an unusual clinical presentation of Acute Lymphoblastic Leukaemia (ALL) in a child from Saudi Arabia. It was reported that a four-year old Saudi girl presented to Abha Maternal and Children’s Hospital in Saudi Arabia suffered with repeated hematemesis. She had a history of fever reaching 39°C, which started 5 days earlier and responded to antipyretics with no chills or rigor. On physical examination, the patient was conscious, alert, pale and lethargic with mild dehydration. Respiratory rate was 30 breaths/minutes, and the heart rate was 135 beats/minutes. Her growth parameters were normal, yet, bone marrow aspirations revealed being markedly infiltrated by blast cells with marked reductions of all normal cells.

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DISCUSSIONS & FINDINGS

ACUTE Lymphoblastic Leukaemia (ALL) is a malignant transformation and proliferation of lymphoid progenitor cells in the bone marrow, blood and extra medullary sites, which mostly occurs 80% among children. It is an aggressive disease which causes an accumulation of immature early bone marrow hematopoietic cells known as “blast cells”. In Saudi Arabia, this particular blood cancer disease constitutes almost 70% of paediatric leukaemia cases in boys, and 69% in girls.

Speaking of the details of the above case, a four-year old Saudi girl who had been medically free before, was investigated on January 12^th 2017 at Abha Maternal and Children’s Hospital in Saudi Arabia with repeated hematemesis. During the last 2 days, there was vomiting around 3-4 times/day with food contents, non-bilious and non-projectile. There was watery diarrhoea around 3 times/day with no mucus or blood. The patient was escorted to a primary health care centre where she was diagnosed as a case of acute gastroenteritis, and oral rehydration therapy was prescribed to her. However, six hours later, she developed hematemesis with large amount more than 7 times with markedly decreased activity.

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Furthermore, the patient had no history of abdominal pain or jaundice, no history of bleeding from any other orifices, no history of severe cough and shortness of breath, no haemoptysis, no abnormal movement or altered level of consciousness, no weight loss, no drug ingestion or foreign body ingestion. There was even no history of any haematological diseases in the family. In fact, the patient was delivered full-term by Caesarean section with no neonatal intensive care admission. Her vaccinations was up-to-date. She was developmentally appropriate to her age, and was on the same family diet.

Next, her father was 50 years old and healthy, so was her mother who was 35 years old and healthy. She had six siblings who were all healthy, and the entire family were living in their own house with a decent amount of income. There was also no history of chronic diseases, or any similar conditions in the family. However, on physical examination, the patient was conscious, alert, pale, and lethargic with mild dehydration. Although she was not jaundiced, afebrile (feverous) and not in respiratory distress, however, her body temperature was 37.7°C, respiratory rate was 30 breaths/minutes, heart rate was 135 beats/minutes, oxygen saturation was 95% in room air, and blood pressure was 101/73 mmHg.

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Finally, the patient was ultimately presented with an unusual clinical symptom with repeated hematemesis that was preceded two days earlier, with vomiting and diarrhoea. She was pale and lethargic with tachycardia, where her bone marrow aspirations revealed being markedly infiltrated by blast cells, with marked reductions of all normal cells. Whatever it is, the case of a young Saudi Arabian girl was diagnosed as the acute leukaemia, or most likely reported as the Acute Lymphoblastic Leukaemia (ALL). Therefore, she was referred to the Comprehensive Cancer Centre at King Fahad Medical City in Riyadh, and her case report became one of the main references for haematology and oncology patients in the Ministry of Health of Saudi Arabia.