Undiagnosed, untreated acute lymphoblastic lymphoma; differential diagnosis between lethal neglect and natural disease

Lethal neglect is a rare cause of death in industrialized countries. In such cases, an accurate differential diagnosis to establish if death results from deliberate neglect, maltreatment and withholding of food instead of nat- ural disease that can mimicking such events, is requested. A 4 months-year-old infant was found unresponsive at home and trans- ported to a local Hospital, where he expired in Emergency Department. Physicians noted child’s cachectic state; the mother stated he had fever, vomiting and diarrhoea from 7 days but she was afraid to seek medical care because was fearful of legal action against her. Crime scene investigation revealed the extremely poor living conditions of the apartment where the 22-years-old mother lived with her parents; the deceased had never been followed by a paediatrician. Autopsy showed the child weighed 4000 g and was 62 cm long. Whole body radiographic examination showed no fractures. A complete lack off in the subcutaneous and deep fat depots with a severe atrophy of skeletal muscles were found; brownish material was found in gastrointestinal tract. Macroscopic and further histological examina- tion showed a T-cell lymphoblastic massive infiltrate of liver, kidneys and other organs with multiple foci of bronchopneumonia in lungs. The cause of death was attributed to a cancer-cachexia-syndrome from Acute Lymphoblastic Lymphoma (LLA). Medico-legal aspects related the liability of the mother in determining her son’s death will be discussed.