Acute Lymphoblastic Leukemia misdiagnosed as lethal child neglect

Lethal child neglect is a rare cause of death in industrialized countries. Starvation and dehydration are peculiar signs of such abuse even if it is mandatory to exclude organic diseases that may mimic neglect. A 4 months-year-old infant started vomiting at his home and then collapsed in a local hospital, where he expired. The mother stated that baby had had symptoms (fever, vomit and diarrhea) but she was afraid to seek medical care. At autopsy, clear signs of dehydration were found. Histological examination showed a T-cell lymphoblastic infiltrate of the organs with foci of bronchopneumonia in lungs. The results of autopsy suggested that the cause of death was a Cancer-Cachexia-Syndrome from an Acute Lymphoblastic Leukemia. The manner of death was attributed to natural death. In the present article, crime scene investigations as well as medical history, autopsy findings, and possible liability of the parents in determining child's death are discussed.