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March 1969

Group D Streptococcal Meningitis Masked by Meningeal Leukemia

Author Affiliations

Bethesda, Md
From the National Cancer Institute (Drs. Skeel, Leventhal, and Henderson) and the National Institute of Allergy and Infectious Diseases (Dr. Wright), National Institutes of Health, Bethesda, Md.

Am J Dis Child. 1969;117(3):334-337. doi:10.1001/archpedi.1969.02100030336017

MENINGEAL leukemia is one of the more frequent complications of acute leukemia, occurring in adults and children during remission and relapse.1-3 Bacterial meningitis, on the contrary, occurs infrequently despite increased susceptibility to infection of patients with acute leukemia.4-6 This report considers the course of a boy with acute lymphocytic leukemia (ALL) and recurrent meningeal leukemia who developed meningitis due to a group D Streptococcus. The diagnosis of an inflammatory condition was not made on morphologic examination of the initial spinal fluid because of pleocytosis showing predominantly immature lymphocytes (diagnostic of meningeal leukemia) and only few polymorphonuclear leukocytes.

Report of a Case  The patient was nearly 8 years old when the diagnosis of ALL was made in October 1964. Several remissions lasting up to one year each were induced with therapy including vincristine sulfate, prednisone, methotrexate, mercaptopurine, and cytarabine hydrochloride. By March 1967, he had relapsed from his sixth

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