Koolman A H, Kamphuis S S M, Weggelaar N M, van den Bos C, Wulffraat N M, Révész T
Afd. Hematologie en Oncologie, Universitair Medisch Centrum, locatie Wilhelmina Kinderziekenhuis, Postbus 85.090, 3508 AB Utrecht.
Ned Tijdschr Geneeskd. 2002 Aug 31;146(35):1613-6.
In two 3-year-old infants, a girl and a boy, systemic juvenile idiopathic arthritis was suspected because of daily fever peaks, signs of polyarthritis and general malaise. Drug treatment was unsuccessful, and after extensive laboratory investigation acute lymphoblastic leukaemia (ALL) was diagnosed and treated adequately. ALL is the most common malignancy in childhood. About one-third of the patients present with joint or bone pain and fever. In this group of children, it can be difficult to identify ALL because it may mimic the clinical picture of systemic juvenile idiopathic arthritis and because of the possibility of a normal blood count at presentation. ALL should always be considered in the differential diagnosis in children with musculoskeletal pain and fever, even in the face of a normal blood count. In any case, a bone-marrow examination should be done before steroid treatment is given.
在两名3岁婴幼儿（一名女孩和一名男孩）中，由于每日出现发热高峰、多关节炎体征和全身不适，怀疑患有全身型幼年特发性关节炎。药物治疗未成功，经过广泛的实验室检查后，诊断为急性淋巴细胞白血病（ALL）并进行了充分治疗。ALL是儿童期最常见的恶性肿瘤。约三分之一的患者表现为关节或骨痛以及发热。在这组儿童中，识别ALL可能很困难，因为它可能模仿全身型幼年特发性关节炎的临床表现，并且就诊时血常规可能正常。对于有肌肉骨骼疼痛和发热的儿童，即使血常规正常，在鉴别诊断中也应始终考虑ALL。无论如何，在给予类固醇治疗之前应进行骨髓检查。
