Demir Ferhat, Eroglu Nilgun, Bahadir Aysenur, Kalyoncu Mukaddes
Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
North Clin Istanb. 2019 May 23;6(2):184-188. doi: 10.14744/nci.2018.48658. eCollection 2019.
Patients with leukemia can be presented with monoarthritis without any hematologic abnormalities. These patients may be misdiagnosed with juvenile idiopathic arthritis (JIA), and the main treatment can also be delayed. An 11-year-old girl was admitted to our pediatric rheumatology outpatient clinic with a 4-week history of swelling in the left ankle. JIA was considered as a preliminary diagnosis after the antinuclear antibody was found to be positive, and non-steroidal anti-inflammatory drug was started. Diffuse bony edema was observed in the talus, navicular, cuboid, and cuneiform bones in magnetic resonance imaging of the left ankle. Despite the treatments, the patient's joint pain increased. There were no abnormalities in repeated peripheral blood smears. On week 3 of follow-up, after bicytopenia was revealed in complete blood count, bone marrow biopsy was performed, and she was diagnosed with precursor B cell acute lymphoblastic leukemia. We presented this case to emphasize that malignancies must be evaluated in the differential diagnosis of patients with arthritis.
白血病患者可能出现单关节炎，而无任何血液学异常。这些患者可能被误诊为幼年特发性关节炎（JIA），主要治疗也可能延迟。一名11岁女孩因左踝肿胀4周入住我们的儿科风湿病门诊。抗核抗体呈阳性后，初步诊断为JIA，并开始使用非甾体抗炎药。左踝关节磁共振成像显示距骨、舟骨、骰骨和楔骨有弥漫性骨水肿。尽管进行了治疗，患者的关节疼痛仍加剧。多次外周血涂片均无异常。随访第3周，全血细胞计数显示双血细胞减少后，进行了骨髓活检，她被诊断为前体B细胞急性淋巴细胞白血病。我们展示这个病例是为了强调在关节炎患者的鉴别诊断中必须评估恶性肿瘤。
