Boccuzzi Elena, Ferro Valentina A, Cinicola Bianca, Schingo Paolo M, Strocchio Luisa, Raucci Umberto
From the Emergency Pediatric Department, Bambino Gesù Children's Hospital, IRCCS.
Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome.
Pediatr Emerg Care. 2021 Jul 1;37(7):e412-e416. doi: 10.1097/PEC.0000000000001694.
Leukemia is the most common childhood malignancy, and it is often characterized by pallor, fatigue, cytopenia, and organomegaly; sometimes musculoskeletal symptoms, mainly characterized by diffuse bone pain in the lower extremities, are the onset clinical characteristics of the disease. In these cases, the disease may initially be misdiagnosed as reactive arthritis, osteomyelitis, or juvenile idiopathic arthritis delaying appropriate diagnosis and management. Even if leukopenia, thrombocytopenia, and a history of nighttime pain are reported to be the most important predictive factors for a pediatric leukemia, blood examinations can sometimes be subtle or within normal limits, and this represents a further diagnostic difficulty. Radiological findings of leukemic bone involvement are described in patients with musculoskeletal symptoms of acute lymphoblastic leukemia and often appear before hematologic anomalies, but they are not specific for the disease. However, they could be helpful to get the right diagnosis if integrated with other features; thus, it is important knowing them, and it is mandatory for the multidisciplinary comparison to talk about dubious cases even in an emergency setting. We describe 4 patients visited in the emergency department for musculoskeletal complaints and having radiological lesions and a final diagnosis of acute lymphoblastic leukemia, in whom the onset of the manifestations could mimic orthopedic/rheumatologic diseases.
白血病是儿童期最常见的恶性肿瘤，其特征通常为面色苍白、乏力、血细胞减少和器官肿大；有时，以双下肢弥漫性骨痛为主的肌肉骨骼症状是该疾病的首发临床特征。在这些情况下，疾病最初可能被误诊为反应性关节炎、骨髓炎或幼年特发性关节炎，从而延误适当的诊断和治疗。即使白细胞减少、血小板减少和夜间疼痛史被报告为小儿白血病最重要的预测因素，但血液检查有时可能不明显或在正常范围内，这进一步增加了诊断难度。急性淋巴细胞白血病肌肉骨骼症状患者白血病骨受累的影像学表现已有描述，且往往在血液学异常出现之前出现，但这些表现对该疾病并无特异性。然而，如果与其他特征相结合，它们可能有助于做出正确诊断；因此，了解这些表现很重要，即使在紧急情况下，多学科会诊讨论可疑病例也是必不可少的。我们描述了4例因肌肉骨骼症状到急诊科就诊、有影像学病变且最终诊断为急性淋巴细胞白血病的患者，其症状的发作可能类似骨科/风湿性疾病。
