Rosati Paola, Jenkner Alessandro, De Vito Rita, Boldrini Renata, Chiodi Patrizia, Celesti Lucia, Giampaolo Rosaria
Department of Paediatric Medicine, Bambino Gesù Children's Hospital, Rome, Italy.
BMJ Case Rep. 2011 Mar 24;2011:bcr1220103611. doi: 10.1136/bcr.12.2010.3611.
A 7-year-old girl was brought to our outpatient clinic to investigate recurrent abdominal pain. She was unwilling to attend the school. Her mother reported bullying at school and nosebleeds. The girl rated her pain 9 on a visual analogue score card ranging from 1 to 10. Physical examination disclosed painful bruising and haematomas. Emergency laboratory blood tests indicated by the history, physical examination and the pain intensity showed reduced numbers of white blood cells and platelets. A bone marrow smear on admission disclosed 100% blasts and suggested an initial diagnosis of leukaemia but also disclosed the pseudo-rosettes typically seen in neuro-ectodermic tumours. The diagnosis of stage IV primary neuroblastoma was confirmed by trephine biopsies and high urinary catecholamines. The girl died 10 months later. This unusual case underlines the need for outpatient paediatricians to involve children in their initial diagnostic work-up by asking them about their pain thus expediting the diagnosis.
一名7岁女孩被带到我们的门诊诊所，以调查反复出现的腹痛。她不愿上学。她的母亲报告称她在学校受到欺负且有鼻出血。女孩在1至10分的视觉模拟评分卡上给自己的疼痛评分为9分。体格检查发现有疼痛性瘀伤和血肿。根据病史、体格检查及疼痛强度进行的急诊实验室血液检查显示白细胞和血小板数量减少。入院时的骨髓涂片显示100%为原始细胞，初步诊断为白血病，但也发现了神经外胚层肿瘤中常见的假玫瑰花结。经环钻活检和高尿儿茶酚胺证实为IV期原发性神经母细胞瘤。该女孩10个月后死亡。这个不寻常的病例强调了门诊儿科医生在初始诊断检查中让儿童参与，询问他们的疼痛情况从而加快诊断的必要性。
