LEUKEMIC PULMONARY INFILTRATES AS A CAUSE OF RESPIRATORY DISTRESS IN CHILDREN:

The clinical and pathological findings in 284 children with acute leukemia who had autopsies over a 22-year period were examined to determine the incidence of pulmonary leukemic infiltrates at the time of death. Six children (2.1%) had acute monocytic leukemia (AMoL), 33 (11.6%) had acute myelogenous or acute monomyelogenous leukemia (AMML) and 245 (86.3%) had acute lymphoid leukemia (ALL). Forty-one of 284 children (14.4%) were found to have 3 distinctive patterns of pulmonary infiltrate. Eleven children (6 ALL, 4 AMML, 1 AMoL) had interstitial infiltrates with or without pleural infiltrates. Seven children (4 ALL, 3 AMML) had parenchymal nodules. Twenty-three children (20 ALL, 2 AMoL, 1 AMML) had perivascular infiltrates with or without peribronchial infiltrates. The presence or absence of infiltrates could not be correlated with leukemic cell type, immunologic phenotype, sex, or white blood cell count at the time of death. Ten of 41 children had respiratory distress (RD) prior to death; however, only 2 of 41 (4.9%) or 2 of 284 (0.7%) had RD which was not explained by active pulmonary infection. We conclude that despite reports of leukemic infiltrates presenting as interstitial pneumonia, pulmonary leukemic infiltrates are a rare cause of RD in the terminally ill child with leukemia.