PARANEOPLASTIC RHEUMATIC DISORDER IN ACUTE LEUKAEMIA: DIAGNOSTIC CONUNDRUM.

Wan Suriana WAN AB RAHMAN^1,4, Wan Majdiah WAN MOHAMAD^1,4, Abu Dzarr GANESH ABDULLAH^2,4, Mohd Nazri HASSAN^3,4, Zefarina ZULKAFLI^3,4, Shafini YUSOF^3,4, Salfarina IBERAHIM^3,4, Noor Haslina MOHD NOOR^3,4, Rosnah BAHAR^3,4, Marini RAMLI^3,4, Marne ABDULLAH^3,4.

¹School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian Kelantan, Malaysia.

²Department of Medicine, School of Medical Science, Universiti Sains Malaysia, 16150 Kubang Kerian Kelantan, Malaysia.

³Department of Hematology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian Kelantan, Malaysia.

⁴Hospital Universiti Sains Malaysia, 16150 Kubang Kerian Kelantan, Malaysia.

ABSTRACT

The association of paraneoplastic rheumatic disorder and acute lymphoblastic leukaemia is rarely reported in the adolescent male. The clinical manifestations develop within two years before the diagnosis of associated malignancy. We report a case of an 18-year-old male, who presented with pyrexia of unknown origin, bicytopenia and autoantibodies that was consistent with the diagnosis of systemic lupus erythematosus. The peripheral blood film was eventually consistent with pancytopenia, devoid of any dysplastic changes or abnormal cells.  When his cytopenia persisted despite empirical steroid therapy, a trephine biopsy revealed a diagnosis of acute lymphoblastic leukaemia. He was started on chemotherapy with UKALL regime and was well in his recent follow-up early this year where he was on maintenance therapy.

Keywords: Acute lymphoblastic leukaemia, Autoimmune, Paraneoplastic syndrome, Rheumatic disorder, Systemic lupus erythematosus.

Corresponding author: Dr Wan Suriana Ab Rahman, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

Phone: +609-7675831; Fax: +609-7675505; E-mail address: suriana@usm.my

Brunei Int Med J.2024;20:19-23