Acute lymphoblastic leukemia masquerading as juvenile rheumatoid arthritis: diagnostic pitfall and association with survival

Abstract

Acute lymphoblastic leukemia (ALL) often presents with osteoarthritic manifestations which may lead to misdiagnosis with juvenile rheumatoid arthritis (JRA). This study was designed to identify ALL patients with initial diagnosis of JRA, compare their clinicolaboratory characteristics and outcome with other ALL patients treated at our center. Case records of 762 patients with ALL were analyzed. Information regarding the clinical-demographic profile, therapy and outcome were recorded. Of the children, 49 (6.4%) had initial presentation mimicking JRA. Asymmetric oligoarthritis was the most common pattern of joint involvement. Majority presented with fever, pallor, arthritis, night pain, and bone pain. None of the routine prognostic factors including age, gender, lymphadenopathy, hepatosplenomegaly, total leukocytes count (TLC), and platelet count were significantly associated with relapse/death. The mean symptom-presentation interval (SPI), hemoglobin was significantly higher whilst the TLC was significantly lower in these patients compared to other ALL patients. The 5 year overall-survival was better than other patients with ALL (p = 0.06, by logrank test). Significantly longer SPI in these patients underscores the need for prompt and early investigations to rule out ALL in patients of JRA with atypical features and pointers of ALL. Children with ALL-mimicking JRA may belong to a subgroup of ALL with a better prognosis.

Síndrome de Goldbloom: síndrome febril prolongado con disproteinemia. Caso clínico

“…Se deben tener en cuenta los síndromes linfoproliferativos, en especial, la leucemia linfoblástica aguda, los linfomas, los síndromes hemofagocíticos, los tumores óseos malignos con metástasis, la drepanocitosis, la enfermedad de Gaucher, la osteomielitis multifocal crónica e infecciones, como tuberculosis o sífilis. 11,12 La enfermedad de Caffey o hiperostosis cortical infantil tiene los mismos signos radiológicos, pero afecta, con mayor frecuencia, los huesos cortos, como la mandíbula y la escápula. Dicha enfermedad se presenta en edades más tempranas y no ocurre con la disproteinemia característica del SG.…”

“…En pocos casos, se han administrado corticoides o colchicina con buena respuesta. [9][10][11][12][13][14] Se han reportado casos de persistencia de las imágenes radiológicas hasta por 2 años.…”

Acute lymphocytic leukemia mimicking spondyloarthritis in an adolescent: A case report and review of the literature

“…This subset of ALL patients may possess an improved prognosis and included an increased percentage of patients opting for therapy or those with a lower total leukocyte count, a higher platelet count and a reduced degree of anemia. Large joints of the limbs were most commonly affected, including the knee, ankle, hip, wrist, elbow and shoulder, while the spine and sacroiliac joint were not mentioned (10). Although peripheral joint involvement is common in LA, axial spinal involvement in leukemia should additionally be considered during the differential diagnosis.…”

“…In the current relevant literature, clinical features, including night pains, alterations in blood counts, an absence of response to NSAID therapy and a fever, were considered to be suspected symptoms of ALL (10,12,13). A low platelet count and night pain that wakes a child from sleep appear to be particularly sensitive indicators of ALL with arthritic symptoms (12,13).…”

“…As ALL typically affects children aged 3-7, and the majority of childhood leukemia cases are ALL, childhood LA is common while adult LA is rarely observed (1) Childhood LA is liable to be misdiagnosed as juvenile idiopathic arthritis (JIA). Marwaha et al (10) retrospectively analyzed the case records of 762 patients exhibiting ALL. The age of onset ranged from 1-14 years, and 49 patients (6.4%) had an initial presentation that mimicked JIA.…”