Barré Alyssa, Hayes Daniel, Dripchak Shawn, Muchow Ryan
University of Kentucky, Department of Orthopaedic Surgery and Sports Medicine, Lexington, KY, USA.
Shriners for Children Lexington, Lexington, KY, USA.
J Pediatr Soc North Am. 2025 May 30;12:100214. doi: 10.1016/j.jposna.2025.100214. eCollection 2025 Aug.
A 7-year-old girl presented with a painful effusion in her right knee, fever, and a negative joint aspirate. One week later, she presented again with an effusion in her left elbow, elevated inflammatory markers, and a joint aspirate that raised concerns for septic arthritis. Irrigation and debridement of the elbow were performed, and the cultures returned negative results. Subsequently, the child experienced ongoing migratory polyarthropathy over several months, which was ultimately identified as leukemia. The initiation of chemotherapy resolved her symptoms. Although the orthopaedic literature is limited, leukemic arthritis should be considered in the differential diagnosis for a pediatric patient with a painful, swollen joint, especially when symptoms migrate without a clear cause.
(1)Leukemic arthritis appears as a painful, swollen joint that is clinically similar to septic arthritis, based on both examination and serum and synovial laboratory values.(2)A prompt diagnosis of acute leukemia is essential as leukemic arthritis can be the first presenting symptom.(3)Recognizing and understanding leukemic arthritis is essential for orthopaedic providers to ensure the timely diagnosis of leukemia and prevent unnecessary procedures and surgeries for these children.
一名7岁女孩因右膝疼痛性积液、发热且关节穿刺检查结果为阴性前来就诊。一周后，她再次因左肘积液、炎症指标升高以及关节穿刺结果引发对化脓性关节炎的担忧而前来。对肘部进行了冲洗和清创，培养结果为阴性。随后，该患儿在数月内持续出现游走性多关节炎，最终被确诊为白血病。化疗的开始缓解了她的症状。尽管骨科文献有限，但对于出现疼痛、肿胀关节的儿科患者，尤其是症状无明显原因而游走时，在鉴别诊断中应考虑白血病性关节炎。
（1）基于体格检查以及血清和滑膜实验室检查值，白血病性关节炎表现为疼痛、肿胀的关节，在临床上与化脓性关节炎相似。（2）由于白血病性关节炎可能是急性白血病的首发症状，因此及时诊断急性白血病至关重要。（3）认识和理解白血病性关节炎对于骨科医护人员确保及时诊断白血病以及防止对这些儿童进行不必要的检查和手术至关重要。
