Ranathunga I, Muthumala N R, Kulathilake H W C K, Weerasinghe S, Shyamali N L A
Professorial Medical Unit, Colombo South Teaching Hospital, Colombo, Sri Lanka.
Department of Haematology, Faculty of Medicine, University of Sri Jayewardenepura, Colombo, Sri Lanka.
Case Rep Hematol. 2020 Aug 25;2020:8889850. doi: 10.1155/2020/8889850. eCollection 2020.
Bone marrow necrosis (BMN) is a rare entity which presents with bone pain, fever, and peripheral cytopenia. Acute lymphoblastic leukaemia (ALL) is characterized by malignant proliferation of immature lymphocytes, and patients usually present with fatigue and bleeding manifestations. Presentation with BMN is an extremely rare finding and only few cases had been reported in the literature. . A 22-year-old male presented with nocturnal lower back ache, pleuritic central chest pain, and fever for two weeks. He was extensively investigated for a cause. His investigations revealed pancytopenia with severe neutropenia. Initial bone marrow aspiration and biopsy did not provide a positive result due to extensive necrosis. However, immunohistochemical analysis of few immature lymphoid cells on repeated BM biopsy showed evidence of acute lymphoblastic leukaemia.
ALL usually presents with fatigue and bleeding manifestations. Presentation with BMN is extremely rare. The diagnosis was extremely challenging as this patient had only occasional atypical cells in the peripheral blood film and the repeat bone marrow (BM) biopsy showed extensive necrosis.
骨髓坏死（BMN）是一种罕见的病症，表现为骨痛、发热和外周血细胞减少。急性淋巴细胞白血病（ALL）的特征是未成熟淋巴细胞的恶性增殖，患者通常表现为疲劳和出血症状。以BMN形式出现极为罕见，文献中仅报道了少数病例。一名22岁男性出现夜间下背部疼痛、胸膜炎性中央胸痛和发热两周。对其病因进行了广泛调查。检查发现全血细胞减少伴严重中性粒细胞减少。由于广泛坏死，最初的骨髓穿刺和活检未得出阳性结果。然而，重复骨髓活检时对少数未成熟淋巴细胞进行免疫组化分析显示有急性淋巴细胞白血病的证据。
ALL通常表现为疲劳和出血症状。以BMN形式出现极为罕见。该诊断极具挑战性，因为该患者外周血涂片仅偶尔有非典型细胞，且重复骨髓活检显示广泛坏死。
