Page 228 - Abstract Book KONIKA 18

Hemato-Oncology

P-HO-005
Hemophagocytic Lymphohistiocytosis in Adolescent: A Case Report

Andyan Yugatama, Amirah Zatil Izzah, Nice Rachmawati Masnadi
Department of Pediatrics Faculty of Medicine Universitas Andalas/Dr. M. Djamil Hospital,
Padang, West Sumatera, Indonesia
Abstract
Background Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening condition that
mimics other diseases. It is usually undiagnosed and delayed treatment is associated with high mortality.
Objective Describes a case of HLH in adolescents which focuses on the problem of late in diagnosis.
Case A 14-year-old girl were admitted for investigation of acute leukemia. She complains fever and pale.
Malnutrition, hepatosplenomegaly, and pancytopenia with absolute neutrophil count <1000 were noted. Bone
marrow aspiration (BMP) did not represent acute leukemia, with the possibility of Chronic Lymphocytic
Leukemia (CLL). A search for metabolic diseases was also carried out and the results were hypoalbuminemia,
hyponatremia, and hypertriglyceridemia. Cases of CLL were very rare in children, so BMP was sent for
second opinion review at the Human Genetic Research Center (HGRC). One week after discharge she
was admitted to ED with septic shock and later died soon afterwards. Results of the BMP from HGRC
came out one month later with an impression of HLH. The patient met the diagnostic criteria for HLH.
Conclusion This case illustrates the importance of suspicion towards the diagnosis of HLH even though
mimicking acute leukemia. Symptoms of HLH are often misleading and have a high mortality in patients
who are not diagnosed in less than 2 months.

Keywords: HLH; rare disease; malignancy

P-HO-006
Bilateral Retinoblastoma in Limited Facilities Health Care: A Case Report

Asna Tuppang, Marshalla Agnes, Junaidi
Wamena General Hospital, Jayawijaya, Papua, Indonesia

Abstract
Background Retinoblastoma is the most common intraocular malignancy in children, with an incidence of
1:15.000 – 1:20.000 live births worldwide. Objective To report a case of bilateral retinoblastoma in health
care with limited facilities. Case A boy, aged 2 years 6 months, came with complaint of a bump in his right
eye since 6 months ago. Initially he complained of red right eye, a white dot appeared in the middle of the
eye and was painful. As time passed, the right eye started to protrude and got bigger as a ping pong ball and
bleeds easily, followed by the appearance of bumps in the front of the ear, lower right jaw to the right neck,
then 2 months later the left eye became blind and changed color into brownish gray. Parents said the boy
lose weight in the past 6 months, the fever went up and down. Parents denied any history of trauma. There
is no history of the disease in the family, no one has tumor and cough more than 2 weeks. Symptomatic
therapy was given by injection of the antibiotic meropenem, paracetamol, Ca gluconate 10%, tranexamic
acid, multivitamins, folic acid, WBC transfusion, management of malnutrition (Diet F75), wound care with
NaCl 0,9% and betadine, and oxygen administration. Conclusion Retinoblastoma should be considered as an
intraocular tumors especially in children until proven otherwise. Specifically in areas with limited facilities,
it is very important to be able to detect early signs of retinoblastoma and avoid development of disease to
worse stage (extraocular retinoblastoma).
Keywords: retinoblastoma; clinical symptoms; diagnosis and management

180 KONIKA XVIII Abstract Book