Diagnosis of malignancies in children with musculoskeletal complaints

Neuroblastoma masquerading as juvenile idiopathic arthritis

“…Neuroblastoma masquerading as juvenile idiopathic arthritis has been reported frequently. 1,2,3,4,5,6 Musculoskeletal complaints may be associated with neoplasias as an initial manifestation of the disease. When these symptoms predominate at the onset of the disease, the differential diagnosis includes several rheumatic diseases.…”

“…When these symptoms predominate at the onset of the disease, the differential diagnosis includes several rheumatic diseases. 2 The common presenting features are those of monoarticular and pauciarticular joint involvement involving the larger joints such as the elbows, knees or ankles. 2,3 Features that are suggestive of malignancy included nonarticular "bone" pain, back pain as a major presenting feature, bone tenderness, severe constitutional symptoms and clinical features "atypical" of most rheumatic disease.…”

“…2,3,5 Aston found hip to be the joint most commonly affected and the most frequent misdiagnosis was suppurative arthritis. 4 The mean time duration between disease onset and final diagnosis generally varies from 15 days to 5 months.…”

“…4 The mean time duration between disease onset and final diagnosis generally varies from 15 days to 5 months. 2,3,6 The most frequent hematological abnormality noted is anemia. 2 Other consistently abnormal laboratory parameters include an increased erythrocyte sedimentation rate and serum lactate dehydrogenase.…”

“…2,3,6 The most frequent hematological abnormality noted is anemia. 2 Other consistently abnormal laboratory parameters include an increased erythrocyte sedimentation rate and serum lactate dehydrogenase. 2,3 Apart from neuroblastoma, other malignancies, which may present with bone/joint symptoms, include acute leukemias, lymphomas and Ewing's sarcomas 2,3 .…”