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Case Reports
. 2020 Aug 25:2020:8889850.
doi: 10.1155/2020/8889850. eCollection 2020.

Extensive Bone Marrow Necrosis: A Rare Presentation of Acute Lymphoblastic Leukaemia

I Ranathunga  1 , N R Muthumala  2 , H W C K Kulathilake  2 , S Weerasinghe  3 , N L A Shyamali  4
Affiliations
Case Reports

Extensive Bone Marrow Necrosis: A Rare Presentation of Acute Lymphoblastic Leukaemia

I Ranathunga et al. Case Rep Hematol. .

Abstract

Background: Bone marrow necrosis (BMN) is a rare entity which presents with bone pain, fever, and peripheral cytopenia. Acute lymphoblastic leukaemia (ALL) is characterized by malignant proliferation of immature lymphocytes, and patients usually present with fatigue and bleeding manifestations. Presentation with BMN is an extremely rare finding and only few cases had been reported in the literature. Case Presentation. A 22-year-old male presented with nocturnal lower back ache, pleuritic central chest pain, and fever for two weeks. He was extensively investigated for a cause. His investigations revealed pancytopenia with severe neutropenia. Initial bone marrow aspiration and biopsy did not provide a positive result due to extensive necrosis. However, immunohistochemical analysis of few immature lymphoid cells on repeated BM biopsy showed evidence of acute lymphoblastic leukaemia.

Conclusions: ALL usually presents with fatigue and bleeding manifestations. Presentation with BMN is extremely rare. The diagnosis was extremely challenging as this patient had only occasional atypical cells in the peripheral blood film and the repeat bone marrow (BM) biopsy showed extensive necrosis.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Bone marrow aspiration (Leishman stain) showing bone marrow necrosis.
Figure 2
Figure 2
Bone marrow trephine biopsy (haematoxylin and eosin) showing extensive bone marrow necrosis.
See this image and copyright information in PMC

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