Sudden unexpected death due to B-cell acute lymphocytic leukaemia (B-ALL) in a 3-year-old child

Sudden unexpected death due to haematologic disease in children is unusual. A 3-year-old girl had been ill for several weeks, but her parents did not consult a doctor. Her complaints included a cough, fever, vomiting and fatigue. On the day of her death, the girl fell from the toilet and was unresponsive. In hospital, severe dyspnoea and a haemoglobin value of only 1.7 mg/dl were diagnosed, as well as hypothermia and haemorrhaging from mouth and nose. Despite intensive medical care and cardiopulmonary resuscitation, the girl died. Main autopsy findings were severe anaemia and the underlying disease, B-cell acute lymphocytic leukaemia (B-ALL). In particular, liver, spleen, lymph nodes, kidneys and bone marrow showed marked infiltration of atypical mononuclear cells replacing haematopoiesis. Intra-alveolar exudation, consistent with the early phase of acute pneumonia, was identified as cause of death. Toxicological investigations revealed positive findings of morphine (53.3 ng/ml), as well as amphetamine and THC in femoral blood, respectively, in hair samples. This paper discusses the medicolegal implications of the case (omitted duty of care by the parents).