Intracerebral hemorrhagic dissemination of acute myelocytic leukemia.

A 10-year-old boy was admitted with left leg pain and fever of 38.9°C. The initial clinical impression was cellulitis. Laboratory findings included hemoglobin of 5 gjdl and white blood cell count of 206,OOOjmma The spleen was enlarged and multiple cervical lymph nodes were palpable. Bone marrow pathology was interpreted as acute myelocytic leukemia. The child was treated with antibiotics , but he soon developed respiratory failure and pericardial effusion. When he suddenly became flaccid and areflexic, cranial CT was performed (fig. 1). He died shortly thereafter. At autopsy, leukemic infiltration was found in the heart, kidneys , pancreas, hypopharynx, lymph nodes, testes , lungs, diaphragm, thyroid, adrenals , liver, spleen , stomach, esophagus, prostate , bone marrow, and brain. Pathologic sections of the brain showed gross nodules consisting of dense aggregates of leukemic cells accompanied by blood suffusion (fig . 2). Marked leukostasis was noted in the vascular lumina at the periphery of these nodules. In the cerebel-