BRIEF REPORT Childhood Acute Lymphoblastic Leukemia Presenting With Severe Hepatic Dysfunction

Children with acute lymphoblastic leukemia (ALL)frequently present with hepatomegaly, but severe hepaticdysfunction caused by leukemic infiltration is rare. Suchpatients often present diagnostic dilemmas because thework-up often focusesonmore commoncauses ofhepaticinjury, delaying final diagnosis. The choice of appropriatetherapy is also difficult because many chemotherapeuticagents are contraindicated in the presence of significanthepatic dysfunction. We discuss here two such childrenwho, in spite of the hepatic abnormality, received anti-neoplastic therapy with a curative intent, resulting incomplete resolution of leukemia in one child and evi-dence of at least partial effectiveness in the other.The first, a 5-year-old girl, was admitted to the St. JudeChildren’s Research Hospital (SJCRH) with a 6-weekhistory of intermittent fever, anorexia, and bone pain. Shewas referred from her local hospital with a hemoglobin(Hgb) level of 82 g/L, platelet count (plt) 107 10