Shen J Z, Wang Y, Fang M Y
Department of Hematology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China.
Zhonghua Nei Ke Za Zhi. 2017 Nov 1;56(11):894-896. doi: 10.3760/cma.j.issn.0578-1426.2017.11.025.
The differential diagnoses of reactive arthritis presenting as arthralgia should be considered as diverse disorders, especially when the symptoms cannot be fully explained by some definite diseases. Do not ignore the indication of bone marrow aspiration. We reported a 50-year-old woman who complained of arthralgia, recurrent fever and rash 9 months ago. Laboratory exams showed mild leukopenia, anemia, thrombocytopenia and increased lymphocyte proportion. She was treated with glucocorticoid after the diagnosis of connective tissue disease was suspected. Until platelet count abruptly decreased to very low level, the final diagnosis of acute lymphoblastic leukemia was made through bone marrow morphology, flow cytometry, and chromosome examination. Therefore, a small number of leukemia is not easily diagnosed by routine operations. Thus when diagnoses are not determined with recurrent symptoms, cautious observation and further examination are required to avoid misdiagnoses or missed diagnoses of acute leukemia.
以关节痛为表现的反应性关节炎的鉴别诊断应被视为多种不同的疾病，尤其是当症状无法被某些明确的疾病完全解释时。不要忽视骨髓穿刺的指征。我们报告了一名50岁女性，她在9个月前出现关节痛、反复发热和皮疹。实验室检查显示轻度白细胞减少、贫血、血小板减少以及淋巴细胞比例增加。在怀疑结缔组织病诊断后，她接受了糖皮质激素治疗。直到血小板计数突然降至极低水平，通过骨髓形态学、流式细胞术和染色体检查最终确诊为急性淋巴细胞白血病。因此，少数白血病通过常规操作不易诊断。所以当反复出现症状而诊断未明确时，需要谨慎观察并进一步检查，以避免急性白血病的误诊或漏诊。
