Infantile High-Grade Glioma : A Case Report from Southern Thailand

Abstract

Background: High-grade gliomas (HGG) in infants under 1 year of age are rare, biologically distinct tumors that often present with subtle, nonspecific symptoms. Early diagnosis remains challenging in resource-limited settings.

Case: We present the case of an 11-month-old Thai girl with one month of progressive early-morning vomiting, irritability, head-grabbing behavior, and recurrent falls. She developed an acute generalized tonic-clonic seizure before hospital arrival. Magnetic resonance imaging revealed a large supratentorial mass with mass effect. Gross total resection was performed. Histopathology demonstrated high-grade glioma with anaplastic features, brisk mitoses, microvascular proliferation, and a Ki-67 index of 35%. Immunohistochemistry showed GFAP positivity, positive H3K27me3, and negative IDH1-R132H. Molecular fusion testing was not available. Postoperative recovery was uneventful, and adjuvant chemotherapy following the Thai POG-BT-131FB protocol was planned.

Discussion: Infantile HGG is a rare and biologically distinct tumor that often presents with nonspecific symptoms, leading to diagnostic delay, particularly in resource-limited settings. In this case, persistent early-morning vomiting and acute seizure activity were key clinical warning signs prompting neuroimaging and timely intervention. Although many infantile hemispheric gliomas are driven by oncogenic kinase fusions, molecular testing was unavailable; therefore, diagnosis relied on characteristic histopathological and immunohistochemical features. Maximal safe resection remains the cornerstone of management and a critical determinant of outcome. Given the substantial neurodevelopmental risks of radiotherapy in infants, chemotherapy-based regimens are favored as first-line adjuvant therapy to achieve disease control while minimizing long-term toxicity.

Conclusion: This case highlights key diagnostic clues for infantile HGG and emphasizes the need for early neuroimaging in infants presenting with persistent vomiting and acute neurological changes. Multimodal treatment -including maximal safe resection and chemotherapy -is essential in this age group.