Serra-Bonett Natalí, Guzmán Yusmary, Rodríguez Ernesto, Millán Alberto, Rodríguez Martín A
Servicio de Reumatología. Centro Nacional de Enfermedades Reumáticas. Caracas. Venezuela.
Reumatol Clin. 2008 Mar;4(2):70-3. doi: 10.1016/S1699-258X(08)71803-5. Epub 2008 Oct 28.
We here present 3 Venezuelan children with acute leukemia, initially diagnosed as idiopathic juvenile arthritis because of the occurrence of pain and joint swelling at the onset of disease. Joint pain was aggravated at night and the arthritis showed a migratory pattern, mainly affecting large joints in an asymmetrical fashion. One patient presented with persistent unilateral sacroiliac pain leading to a wrong diagnosis of spondyloarthritis. The elevation of acute phase reactants, disproportionate to the extent of joint disease, and marked elevation of serum lactate dehydrogenase, as well as characteristicradiological changes allowed the correct diagnosis in all cases. This combination of clinical manifestations, clinical laboratory findings, and joint and bone imaging should prompt the clinician to an early diagnosis of acute leukemia in children with arthritis.
我们在此报告3例委内瑞拉急性白血病患儿，这些患儿在疾病初期因出现疼痛和关节肿胀而最初被诊断为特发性幼年型关节炎。关节疼痛在夜间加重，且关节炎呈游走性，主要不对称地累及大关节。1例患者出现持续性单侧骶髂关节疼痛，导致误诊为脊柱关节炎。急性期反应物升高程度与关节疾病程度不成比例、血清乳酸脱氢酶显著升高以及特征性的放射学改变使得所有病例均得以正确诊断。这种临床表现、临床实验室检查结果以及关节和骨骼影像学检查结果的组合应促使临床医生对患有关节炎的儿童早期诊断急性白血病。
