Musculoskeletal manifestations with subtle haematological and radiological abnormalities in childhood acute lymphoblastic leukaemia

SHALIZA NS, FAIZAL A HAMZAH, H EMBONG

Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

ABSTRACT

Musculoskeletal manifestations may be the only apparent abnormality at the onset of disease in childhood acute lymphoblastic leukaemia (ALL). These clinical presentations are often misdiagnosed as diverse forms of orthopaedic and rheumatologic disease, therefore contributes to delay in diagnosis and treatment. We report the case of a 3-year-old child who was diagnosed with ALL after recurrent visits with persistent painful left ankle swelling. Initial haematological and radiological findings revealed subtle abnormalities. A bone marrow aspiration confirmed the diagnosis of precursor-B ALL. This case highlights that acute leukemia needs to be considered in the differential diagnosis in any child presenting with musculoskeletal pain and unexplained lymphocytosis and neutropenia. Radiological abnormalities include diffuse osteopaenia, radiolucent metaphyseal bands, osteolytic lesion and sclerotic lesions which may raise the suspicion of acute leukemia, but are not always pathognomonic. Delay in diagnosis and treatment may have a deleterious impact on prognosis.

Keywords: Childhood leukemia, lymphocytosis, cellulitis, atypical manifestations

Correspondence author: Nurul Shaliza Shamsudin,

Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras Kuala Lumpur, Malaysia.

Tel: +603-91455491.

E mail: shalit282@yahoo.com

Brunei Int Med J. 2014; 10 (5): 293-296