This report describes a previously healthy toddler initially diagnosed with acute myelogenous leukemia with monocytic features and a bilateral thalamic high grade glioma at initial presentation. However, review of the outside hospital imaging favored bilateral thalamic infarcts with hemorrhagic conversion; the diagnosis of near diffuse cerebral venous sinus thrombosis (CSVT) with hemorrhagic conversion was confirmed with CT venography. He succumbed to uncontrollable intracranial pressure despite surgical decompression, medical management, anticoagulation, and chemotherapy. CSVT is the most common thrombotic complication present at diagnosis in AML and associated with high mortality, and diagnosis requires a high level of suspicion.

Risk stratification of pediatric febrile neutropenia (FN) is an established concept; the internal evaluation of a validated clinical decision rules (CDR) tool has not been well-described. In this study, restrictive criteria and procalcitonin were added to a recommended CDR for internal evaluation before implementation. Analysis of 577 FN episodes showed good sensitivity and negative predictive value in predicting blood stream infections (87.3%; 95.6%) and intensive care admissions (97.2%; 99.1%). There were no severe adverse events in low-risk patients with low procalcitonin; procalcitonin identified 3 low-risk patients with serious bacterial infections. The modified CDR with procalcitonin may assist in risk stratification.