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从骨科角度看小儿白血病：一例最初被误诊为伴有骨髓炎的化脓性髋关节炎的急性淋巴细胞白血病病例

Pediatric Leukemia From an Orthopedic Perspective: A Case of Acute Lymphoblastic Leukemia Initially Managed as Septic Hip With Osteomyelitis.

作者信息

Gkoudina Antigoni, Gekas Christos, Polydorides Marianna, Graikos Georgios, Papakonstantinou Evgenia, Saloupis Panagiotis

机构信息

Orthopedics and Traumatology, General Hospital of Pella, Edessa, GRC.

Orthopedics and Traumatology, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, GRC.

出版信息

Cureus. 2022 Apr 13;14(4):e24103. doi: 10.7759/cureus.24103. eCollection 2022 Apr.

DOI:10.7759/cureus.24103
PMID:35573545
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9106539/
Abstract

Acute lymphoblastic leukemia (ALL) represents the most common pediatric cancer accounting for about one-third of all malignancies in childhood. The differential diagnosis for a pediatric patient manifesting with joint pain and refusal to bear weight is wide and includes trauma, transient synovitis, septic arthritis, rheumatologic disorders, and malignancy. Overt complaints from the musculoskeletal system as the initial manifestation of ALL may present in up to 30% of cases with normal laboratory tests and without hepatosplenomegaly or lymphadenopathy, perplexing the establishment of a definite diagnosis. Herein, we report the case of a three-year-old male who presented with recurrent hip pain and fever masquerading as septic arthritis recalcitrant to intravenous (IV) antibiotics, irrigation, and debridement of the hip joint with a final diagnosis of acute lymphoblastic leukemia confirmed by bone marrow biopsy.

摘要

急性淋巴细胞白血病（ALL）是最常见的儿童癌症，约占儿童所有恶性肿瘤的三分之一。表现为关节疼痛和拒绝负重的儿科患者的鉴别诊断范围广泛，包括创伤、短暂性滑膜炎、化脓性关节炎、风湿性疾病和恶性肿瘤。ALL最初表现为骨骼肌肉系统明显症状的情况，在高达30%的病例中可能出现实验室检查正常且无肝脾肿大或淋巴结病，这使得明确诊断的确定变得复杂。在此，我们报告一例3岁男性病例，该患者表现为反复髋关节疼痛和发热，伪装成静脉注射（IV）抗生素、髋关节冲洗和清创治疗无效的化脓性关节炎，最终经骨髓活检确诊为急性淋巴细胞白血病。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/8908a8d931fc/cureus-0014-00000024103-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/660eebd8527f/cureus-0014-00000024103-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/86365e97b3cf/cureus-0014-00000024103-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/ba7cbb85d4ec/cureus-0014-00000024103-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/afa30487db7a/cureus-0014-00000024103-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/9dea378df435/cureus-0014-00000024103-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/f2eab3ea4ce7/cureus-0014-00000024103-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/8908a8d931fc/cureus-0014-00000024103-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/660eebd8527f/cureus-0014-00000024103-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/86365e97b3cf/cureus-0014-00000024103-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/ba7cbb85d4ec/cureus-0014-00000024103-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/afa30487db7a/cureus-0014-00000024103-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/9dea378df435/cureus-0014-00000024103-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/f2eab3ea4ce7/cureus-0014-00000024103-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e0d/9106539/8908a8d931fc/cureus-0014-00000024103-i07.jpg

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本文引用的文献

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Extramedullary manifestations in acute lymphoblastic leukemia in children: a systematic review and guideline-based approach of treatment.儿童急性淋巴细胞白血病的髓外表现：一项基于系统评价和指南的治疗方法
Am J Blood Res. 2020 Dec 15;10(6):360-374. eCollection 2020.
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Pediatric acute lymphoblastic leukemia.小儿急性淋巴细胞白血病。
Haematologica. 2020 Nov 1;105(11):2524-2539. doi: 10.3324/haematol.2020.247031.
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Orthopedic manifestation as the presenting symptom of acute lymphoblastic leukemia.骨科表现作为急性淋巴细胞白血病的首发症状
J Orthop. 2020 Jun 7;22:326-330. doi: 10.1016/j.jor.2020.05.022. eCollection 2020 Nov-Dec.
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Acute lymphoblastic leukaemia.急性淋巴细胞白血病。
Lancet. 2020 Apr 4;395(10230):1146-1162. doi: 10.1016/S0140-6736(19)33018-1.
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Persistent osteoarticular pain in children: early clinical and laboratory findings suggestive of acute lymphoblastic leukemia (a multicenter case-control study of 147 patients).儿童持续性骨关节炎疼痛：提示急性淋巴细胞白血病的早期临床和实验室发现（147 例多中心病例对照研究）。
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Acute lymphoblastic leukemia masquerading as juvenile rheumatoid arthritis: diagnostic pitfall and association with survival.伪装成幼年型类风湿关节炎的急性淋巴细胞白血病：诊断陷阱及与生存的关联
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