Case presentation An 11-year-old male with attention deficit hyperactivity disorder (ADHD) presented to a pediatrician with an unintentional weight loss of 20 lbs. The weight loss was initially attributed to ADHD medications; however, with further clinical evaluation, the physician suggested a diagnosis of cervical lymphadenopathy.
Laboratory workup Hemoglobin: 10.8 g/dL WBC count: 210,000 cells/μL Neutrophils: 65% Band cells: 6% Lymphocytes: 5% Monocytes: 3% Eosinophils: 2% Metamyelocytes: 3% Myelocytes: 13% Promyelocytes: 2% Blasts cells: 1% blasts MCV: 92 fL LDH: 1,858 U/L Uric acid: 7.0 mg/dL Other diagnostic evaluations Abdominal CT scan showed splenomegaly. Bone marrow study: Hypercellular marrow (>95%) with increased myeloid cells at all stages of maturation, increased eosinophils, scattered basophils, few erythroid progenitors, so-called dwarf megakaryocytes, and sea-blue…
