Psychiatric presentation of a secondary high-grade glioma in a teenager with high-risk pre-B-cell acute lymphoid leukaemia in remission

Following evaluation in the emergency room demonstrating absence of any focal neurological sign, she was transferred to an inpatient psychiatric facility. Five days following admission, she was sent to the emergency room for evaluation of altered mental status, atypical episodes of enuresis and headaches. The overall cumulative incidence of brain tumours in children treated for childhood acute lymphoblastic leukaemia is under 2% based on a study population of 1612 consecutive patients treated at St. Jude Children’s Research Hospital.3 Only 10 of 1612 patients had developed high-grade glioma at a median latency of 9.1 years.3 Risk factors for secondary brain cancers include history of radiation therapy and germline mutations, both of which were present in our patient.3–5 Familial TP53 mutation, Li-Fraumeni syndrome, is a cancer predisposition condition which has been implicated in childhood acute lymphoblastic leukaemia with a risk of up to 50% within 49 years after first diagnosis of secondary malignancy.4 6 Our case highlights a primary psychiatric presentation of a secondary malignancy, even in the absence of any focal neurological signs.