Juvenile myelomonocytic leukemia presenting with coexistent cytomegalovirus infection--a case report.

We report a case of juvenile myelomonocytic leukemia (JMML) with coexistent cytomegalovirus (CMV) infection in a 10-month-old child that caused initial diagnostic dilemma. The patient presented with fever, anemia, lymphadenopathy, and hepatosplenomegaly. The peripheral blood smear and bone marrow aspirate examination showed monocytosis, leukoerythroblastosis, myeloid hyperplasia, and increased blasts. Serologic test for CMV was positive and thus the hematologic picture was attributed to CMV infection and gancyclovir was started. The patient, however, did not improve clinically. A repeat peripheral smear and marrow showed persistence of the above picture and a diagnosis of JMML was made. Viral infections in young children may present with hematologic features overlapping with JMML and simultaneous occurrence of both may cause diagnostic dilemma.