A case report on suspected malignancy in a 9-year-old: economic and diagnostic challenges in pediatric oncology in resource-limited settings

Background: Diagnostic and economic challenges are part of the causes of delay in diagnosis which may contribute to poor outcomes in paediatric malignancies. We share experience of a patient with a diagnostic dilemma complicated with financial constraints in the setting of limited paediatric oncology care services.Case Report: A 9 year old boy presented with recurrent fever and cough of 6 months, weight loss and multiple painless nodular swellings on the neck and both armpits of one month. There was associated drenching night sweat. Initially there was no difficulty with breathing but he later developed difficulty with breathing with persistence of earlier mentioned symptoms. He had grade 4 finger clubbing and hepatomegaly. Chest x-ray showed near homogenous opacities on both middle lung zones, ESR was markedly raised (100.0mm/hr).Histology of excised cervical lymph node reported reactive lymphoid hyperplasia. Chest CT-Scan revealed multiple pulmonary nodules, pulmonary infiltrates, mediastinal and cervical lymphadenopathies. Differential diagnoses considered were Tuberculosis and Non-hodgkin lymphoma. Investigations were delayed due to financial constraints. He was referred to another facility with advanced paediatric oncology services but parent left for home due to financial constraints.Conclusion: This case report draws attention to diagnostic challenges that may be associated with paediatric malignancies particularly in resource limited settings. It also highlights the need for the implementation of Universal Health Coverage to make health care services readily accessible for all.