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. 2020 Jun 7:22:326-330.
doi: 10.1016/j.jor.2020.05.022. eCollection 2020 Nov-Dec.

Orthopedic manifestation as the presenting symptom of acute lymphoblastic leukemia

Amrath Raj B K  1 , Kumar Amerendra Singh  2 , Hitesh Shah  1
Affiliations

Orthopedic manifestation as the presenting symptom of acute lymphoblastic leukemia

Amrath Raj B K et al. J Orthop. .

Abstract

Introduction: The diagnosis of Acute lymphoblastic leukemia (ALL) is delayed due to vague presentation and normal hematological investigations.

Objective: The objectives were to identify the frequency of ALL cases presented to the orthopedic department and with normal hematological investigations.

Material and methods: 250 consecutive ALL cases were retrospectively evaluated to identify cases with musculoskeletal manifestations, and laboratory investigations.

Results: Twenty-two patients (4- vertebral compression fractures, 12- joint pain, 6- bone pain), presented primarily to the orthopedic department. Six patients had a normal peripheral smear.

Conclusion: The primary physician should maintain a high index of suspicion despite a normal peripheral smear.

Keywords: Acute lymphoblastic leukemia; Bone pain; Childhood leukemia; Orthopedic manifestation.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
A four-year girl with one-month history of back-pain and stiffness as seen with presence of coin test. Her blood parameters were normal. Bone marrow biopsy confirmed the diagnosis.
Fig. 2
Fig. 2
Spine radiograph of the same child revealed multiple wedge compression fractures of the vertebrae. She was not having neurological deficit.
Fig. 3
Fig. 3
Normal trabecular pattern and density in the radiograph of a four-year patient who was referred with right hip pain and pseudo-paralysis. Passive range of movements, blood parameters and ultrasonography were normal. Bone marrow biopsy confirmed the diagnosis of ALL.
Fig. 4
Fig. 4
Three-year follow-up radiograph of the child in Fig. 1. Back-pain and stiffness improved with the treatment. Vertebral heights have improved.
Fig. 5
Fig. 5
Diagnostic workflow to evaluate a child with musculoskeletal pain.
See this image and copyright information in PMC

References

    1. Meehan P.L., Viroslav S., Schmitt E.W. Vertebral collapse in childhood leukemia. J Pediatr Orthop. 1995;15(5):592–595. - PubMed
    1. Rogalsky R.J., Black G.B., Reed M.H. Orthopaedic manifestations of leukemia in children. J Bone Joint Surg Am. 1986 Apr;68(4):494–501. http://www.ncbi.nlm.nih.gov/pubmed/3957974 [cited 2020 Apr 7] Available from: - PubMed
    1. Gallagher D.J., Phillips D.J., Heinrich S.D. Orthopedic manifestations of acute pediatric leukemia. Orthop Clin North Am. 1996 Jul;27(3) http://www.ncbi.nlm.nih.gov/pubmed/8649744 [cited 2020 Apr 7] 635–44. Available from: - PubMed
    1. Kayser R., Mahlfeld K., Nebelung W., Grasshoff H. Vertebral collapse and normal peripheral blood cell count at the onset of acute lymphatic leukemia in childhood. J Pediatr Orthop B. 2000 Jan;9(1) [cited 2020 Apr 6] 55–7. Available from http://www.ncbi.nlm.nih.gov/pubmed/10647113. - PubMed
    1. Tuten H.R., Gabos P.G., Kumar S.J., Harter G.D. The limping child: a manifestation of acute leukemia. J Pediatr Orthop. 1998;18(5) http://www.ncbi.nlm.nih.gov/pubmed/9746414 [cited 2020 Apr 6] 625–9. Available from: - PubMed

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