Abstract
Childhood cancer is a rare condition. Motor dysfunction may be an initial manifestation of a solid tumor, particularly when caused by spinal or vascular compression. However, in infants who have only recently begun to walk, such symptoms may be misinterpreted as normal developmental variations. Additionally, vascular signs such as delayed capillary refill time (CRT) are extremely rare and may easily be overlooked in clinical practice. Prompt diagnosis and intervention are essential to preserve neurological function in cases of spinal cord compression. Nevertheless, due to the rarity of such presentations, primary care providers, including pediatricians, may have limited experience. A 20-month-old girl presented with right lower limb weakness, bladder and bowel dysfunction, and fever. She had begun walking at 12 months but developed a limp at 18 months. One month prior to admission, she exhibited sensory deficits and diminished reflexes in the right leg, which were initially attributed to her history of prematurity at birth. At 20 months of age, she stopped using her right leg entirely and was admitted to our hospital. Physical examination revealed decreased muscle strength of the right lower limb (knee and ankle joints, manual muscle test grade 4), coldness and prolonged CRT in the right foot, and right thigh swelling (right 26 cm; left 23.5 cm). Computed tomography revealed a large pelvic mass compressing the vasculature and spinal cord, along with another mass from T7 to T9. Multimodal chemotherapy was initiated immediately prior to establishing a final diagnosis. Capillary refill improved within one week, and the thigh asymmetry resolved by day 11. The final histological diagnosis confirmed stage 4 embryonal rhabdomyosarcoma. A very good partial response was achieved after 12 months of treatment. She regained partial ambulation using a brace; however, bladder and bowel dysfunction persisted. This case highlights the diagnostic challenges in identifying malignancy in young children presenting with subtle neurological or vascular symptoms. Previous reports on impaired blood flow in the lower extremities among pediatric cancer patients, including those with rhabdomyosarcoma, have been limited. Although rarely reported in the literature, such presentations are occasionally encountered in daily clinical practice. Previous studies have shown that delayed diagnosis of spinal cord compression is associated with poorer neurological outcomes, particularly in younger patients. Earlier recognition of asymmetry and impaired perfusion in the lower limbs might have enabled more timely diagnosis and intervention in this case.