Acute lymphoblastic leukemia mimicking evan syndrome: A case report with review of literature

Acute lymphoblastic leukemia (ALL) is a cancer of lymphoid precursor cells, commonly affecting children. Symptoms include fever, pallor, bruising, and organ enlargement. Five-year survival rates exceed 85 %, though relapse outcomes are poor. Diagnosis involves bone marrow examination and flow cytometry. Treatments include steroids and chemotherapy. A 14-year-old Asian boy presented with fatigue, jaundice, pallor, and low-grade fever. He had no history of infections or any comorbidities. Initial labs showed pancytopenia, prompting admission. Examination revealed cervical lymphadenopathy, pallor, jaundice, and bicytopenia. Over the course of the hospital stay, further tests ruled out liver disease, Hepatitis, and HIV. Bone marrow-related causes such as aplastic anemia, myelofibrosis, and lymphoproliferative/myelodysplastic disorders were excluded based on CBC, peripheral film, and bone marrow aspiration results. Eventually, flow cytometry confirmed precursor B-cell acute lymphoblastic leukemia (ALL). Despite treatment, the patient succumbed to hypovolemic shock following severe hematemesis. This case highlights the importance of considering the genetic profile in diagnosis, as relying solely on CBC, peripheral smear, and bone marrow biopsy may not be sufficient to rule out conditions like ALL, which can mimic autoimmune hemolytic diseases.