# Unusual Presentation of Childhood Leukemia With Vaginal Bleeding: A Case Report

## TL;DR

A 17-year-old girl with vaginal bleeding and weight loss was diagnosed with B-cell acute lymphoblastic leukemia, highlighting the need to consider rare conditions in atypical cases.

## Contribution

This case report presents an unusual presentation of B-ALL with vaginal bleeding, emphasizing the importance of thorough evaluation in young patients.

## Key findings

- Vaginal bleeding in a young patient was linked to B-cell acute lymphoblastic leukemia.
- Weight loss and thrombocytopenia were key indicators prompting further investigation.
- Early diagnosis and treatment improved the patient's prognosis.

## Abstract

Introduction: This case report describes a 17-year-old female patient who initially presented with vaginal bleeding, weight loss, and nonspecific symptoms, which led to the diagnosis of B-cell acute lymphoblastic leukemia (B-ALL). This unusual presentation highlights the importance of considering hematological malignancies in patients with atypical symptoms.

Case Presentation: The patient, married for 2 weeks, experienced vaginal bleeding following her first sexual intercourse, which did not resolve spontaneously. She also reported a 6 kg weight loss over the past 3-4 months, hair loss, and a history of dysmenorrhea and an ovarian cyst detected 2 years prior. Laboratory investigations revealed leukocytosis (WBC: 16,500/μL), anemia (Hb: 11.4 g/dL), and thrombocytopenia (Plt: 44,000/μL). Bone marrow aspiration (BMA) and flow cytometry confirmed the diagnosis of B-ALL, revealing a high percentage of atypical lymphoid cells.

Discussion: This case underscores the rarity of diagnosing hematological malignancies in patients with vaginal bleeding. The patient's symptoms, including weight loss and thrombocytopenia, should have prompted a more comprehensive evaluation. Early recognition of B-ALL is crucial as prompt treatment significantly improves outcomes. The patient was started on prednisolone and alkalinized fluids, and her condition was closely monitored.

Conclusion: Vaginal bleeding in young patients should not be dismissed as a minor issue, especially when accompanied by other systemic symptoms like weight loss and thrombocytopenia. Early diagnosis of B-ALL in such cases can lead to better management and prognosis.