Warm autoimmune hemolytic anemia revealing a mature Altman type II sacrococcygeal teratoma in a 1-month-old infant: A case report

Abstract

Introduction Sacrococcygeal teratoma is the most common congenital neoplasm and predominantly affects female infants. Warm autoimmune hemolytic anemia (WAIHA) is rare in childhood, and its association with teratoma, particularly sacrococcygeal teratoma, is exceptionally uncommon. Case Presentation We report a 1-month-old female infant admitted for severe WAIHA revealed by acute jaundice, dark urine, hepatosplenomegaly, profound regenerative anemia, and a direct antiglobulin test positive for immunoglobulin G. Clinical examination identified a sacrococcygeal mass, and pelvic magnetic resonance imaging demonstrated a solid-cystic lesion with significant intrapelvic extension, suggestive of an Altman type II sacrococcygeal teratoma. Initial management included packed red blood cell transfusions, intravenous methylprednisolone followed by oral prednisone, and folic acid supplementation. Complete surgical excision with coccygectomy was performed, and histopathological examination confirmed a mature teratoma without malignant features. Hemoglobin normalized by postoperative day 15, the direct Coombs test became negative, and the child remained clinically well at 2 years of follow-up, with preserved psychomotor development, walking, posture, and fecal continence. Conclusion Severe WAIHA in an infant with a sacrococcygeal mass should prompt evaluation for a tumor-associated process, as complete tumor excision may be followed by hematologic remission.