What are the constitutional signs and symptoms of pediatric acute myelocytic leukemia (AML)?

Updated: Sep 12, 2017
  • Author: Mark E Weinblatt, MD; Chief Editor: Jennifer Reikes Willert, MD  more...
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Unexplained, persistent fevers are sometimes the only presenting symptom of patients with leukemia. Weight loss and cachexia are unusual findings in children with leukemia but not in adults. These effects can result from an increased catabolic nutritional state combined with decreased caloric intake from anorexia.

Bone pain is less common in patients with acute myelocytic leukemia than in patients with ALL. Its cause may be periosteal elevation due to leukemic cell infiltrates or bone infarctions. On occasion, weakened bony cortex permits pathologic fractures of the extremity, which result in pain and decreased mobility, or vertebral compression fractures after minimal trauma. Such compression fractures cause back pain and dysfunction of the lower extremity (eg, weakness, loss of bladder and bowel function).

CNS symptoms, although uncommon initially, can appear during follow-up with various findings. The most common signs and symptoms are related to elevated intracranial pressure, including headache, nausea and emesis, lethargy, irritability, and visual complaints.

Involvement of cranial nerves, most often the facial nerve (resulting in Bell palsy) and the abducens nerve (resulting in esotropia), may be isolated or may occur in combination with other manifestations.

In addition to infiltration and proliferation of leukemic cells with mass effect, intracranial hemorrhage and CNS infections can cause similar devastating CNS complications.

Spinal lesions are rare.

In acute myeloid leukemia, blast cells periodically form large aggregates called chloromas or granulocytic sarcomas, leading to epidural compression. Extreme leukocytosis with WBC counts of more than 200 X 109/L is often associated with hyperviscosity, intracerebral leukostasis, and intracerebral hemorrhage early in the course.

In rare cases, leukemic cells infiltrate all parts of the eye. The retina and iris are the sites most commonly affected. Iritis often causes photophobia, pain, and increased lacrimation, whereas retinal involvement is often accompanied by hemorrhage and can lead to a loss of vision.

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