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Isolated Gut Relapse Presenting as Chronic Diarrhea During Maintenance Therapy for Acute Lymphoblastic Leukemia

Bhatti, Anuj MD*; Bansal, Deepak MD, DNB*; Vashishta, Rakesh K. MD, FRCPath; Lal, Sadhna B. MD, DM

Journal of Pediatric Hematology/Oncology: August 2010 - Volume 32 - Issue 6 - p 504-505
doi: 10.1097/MPH.0b013e3181e0159a
Clinical and Laboratory Observations

Ten-year-old boy with acute lymphoblastic leukemia (ALL)-T cell subtype was on MRC UKALL 2003-based chemotherapy. Bone marrow attained remission after induction. After 8 months into maintenance, he presented with chronic diarrhea and weight loss. Search for infective and malabsorptive etiology was unrewarding. Infiltration with leukemic cells was seen in the lamina propria on mucosal biopsies of duodenum and colon. Marrow was in remission. Isolated gut relapse is exceedingly rare. It should be considered in the etiology of chronic diarrhea in patients with ALL, after common causes are excluded.

*Division of Pediatric Hematology and Oncology, Department of Pediatrics, Advanced Pediatrics Centre

Department of Histopathology

Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Reprints: Deepak Bansal, MD, DNB, Hematology-Oncology division, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India (e-mail:

Received for publication November 7, 2009; accepted March 5, 2010

© 2010 Lippincott Williams & Wilkins, Inc.