malignancy in a child?

[charlic]

Hi, my daughter age 7 first started being ill this time last year- lethargic, nosebleeds, pale,leg pain, fevers, swollen lymph glands. She was admitted to hospital after an abnormal blood count,platlets low, white blood count high and her neutrophils were 0.32- very low. We were told either to expect mono or at the worst bone marrow displasia or even leukemia. Her spleen was very inlarged. We finally got a diagnosis of EBV, she had every blood test known including aauto immune disorders. And we did have to keep having repeat blood counts until they went back to normal. Then this year I noticed a swelling on her left breast, she was also acting very sensitive and moody. Her doctor suspected precocious puberty and referred us to an endocrinologist who has up to now done a bone xray which was normal but confirmed she has developed in some areas consistant with puberty. She is scheduled for hormone tests next week and an mri scan which we dont have the appointment for yet. Now for the past 3 weeks she has been very poorly. Random fevers again, leg pain again, very pale and huge swollen lymph glands on her neck and groin. We were told she had a virus. Then she had really bad mouth sores which again was diagnosed as a virus. We went to see a different doctor and she gave us antibiotics which did seem to help for a couple of days but then the fever returned. We went to see our gp again this week and he sent us to the hospital for a full blood count- which was normal. The past two days she has been well and been back in school but now today the fever has come back again and she is very pale, bruised eyes and very prominent veins are showing on her skin. Any one have any ideas??? I know its not leukemia and we would have know by now, we know its not any immune disorder because she has been tested. Im now thinking lymphoma? But would the blood count come back abit wacko? Im thinking 3-4 weeks of random fevers and mouth sores and swollen glands isnt normal or am i just panicking? any info appreciated, thanks u :)

[Ken_PA]

Hi, if you look into periodic fever syndromes and immunodeficiency conditions, you'll see some of the mystery illnesses that can exist in children.

I'd also keep a food diary, to try and see if anything she's eating may be a trigger.

Also, I'd say that diagnosing autoimmunity is not a cut and dry proposition. While some autoimmune diseases may have been ruled out, that doesn't mean they all are ruled out.

[charlic]

thank you for your reply, she is still unwell, now with a sore throat and a cough, the cough though doesnt affect her at night which is strange , she hasnt coughed once during her sleep. She has this weekend also complained of itchy skin on her legs. We did take her to her doctor on friday and she said its a misture of virus's and infections and can be normal for them to last this long. She also conformed she has lost a considerable amount of weight but saying that she has had days of not eating due to feeling poorley.You have reassured now though and thank you for that, I will just monitor her and see hoe she goes, thanks again

[Mochadelicious]

Your daughter seems to have a lot of symptoms, none of which when put together makes me believe she has lymphoma.  She has some symptoms of what could be lymphoma, but a lot of her other symptoms don't really fit.  

Many people with lymphoma don't have any symptoms other than a swollen lymph node, however, over time if untreated, B symptoms can occur.  B symptoms are fever, weight loss (at leat 10% over 6 mo.), and drenching night sweats.  Some people also develope itching.  You also have lymphoma and still have normal blood work.

EBV can be linked to lymphoma, but from what I understand many people get EBV and never develope lymphoma.   The only way to know for sure if you're dealing with lymphoma is with a biopsy.  Scans are usually used after a biopsy to determine the staging.

You are right, though.  3-4 weeks of fevers, mouth sores and swollen glands is too long.  I would think that the antibiotics would have taken care of these things long ago.  If I were you, at this point, I would probably talk to her GP about doing a possible biopsy of her lymph nodes.  

Another argument against lymphoma: 70% of NHL occurs in people over the age of 50, making this diagnosis highly unlikely for your daughter.    

[charlic]

also would like to add that her tonsils are huge and always have been since the EBV diagnosis, never been infected though, she does complain of sore throat sometimes and dizziness. When we went to see the doc over her mouth sores she felt her swollen nodes and asked to see us again a week later and commented that she thought she needed her tonsils out- which I thought was strange seeming as though they havnt caused her any problems