Difficulty in the diagnosis of bone and joint pain associated with pediatric acute leukemia; comparison with juvenile idiopathic arthritis

Tsujioka, Takao; Sugiyama, Minako; Ueki, Minoru; Tozawa, Yusuke; Takezaki, Shunichiro; Ohshima, Junjiro; Cho, Yuko; Yamada, Masafumi; Iguchi, Akihiro; Kobayashi, Ichiro; Ariga, Tadashi

doi:10.1080/14397595.2017.1332474

Cited by 11 publications

(19 citation statements)

References 16 publications

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“…Bone disease: osteofibrous disease, osteoid osteoma [94][95][96][97][98]. Neoplastic: Langerhans cell histiocytoma, leukemia-associated osteoarthralgia, sarcoma [99,100]. Osteonecrosis: 15-47% of pediatric patients after high-dose glucocorticoids.…”

Section: Pathogenic Bme In Childrenmentioning

confidence: 99%

How We Manage Bone Marrow Edema—An Interdisciplinary Approach

Baumbach

Pfahler

Pozza

et al. 2020

JCM

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Bone marrow edema (BME) is a descriptive term for a common finding in magnetic resonance imaging (MRI). Although pain is the major symptom, BME differs in terms of its causal mechanisms, underlying disease, as well as treatment and prognosis. This complexity together with the lack of evidence-based guidelines, frequently makes the identification of underlying conditions and its management a major challenge. Unnecessary multiple consultations and delays in diagnosis as well as therapy indicate a need for interdisciplinary clinical recommendations. Therefore, an interdisciplinary task force was set up within our large osteology center consisting of specialists from internal medicine, endocrinology/diabetology, hematology/oncology, orthopedics, pediatrics, physical medicine, radiology, rheumatology, and trauma surgery to develop a consenus paper. After review of literature, review of practical experiences (expert opinion), and determination of consensus findings, an overview and an algorithm were developed with concise summaries of relevant aspects of the respective underlying disease including diagnostic measures, clinical features, differential diagnosis and treatment of BME. Together, our single-center consensus review on the management of BME may help improve the quality of care for these patients.

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Section: Pathogenic Bme In Childrenmentioning

confidence: 99%

How We Manage Bone Marrow Edema—An Interdisciplinary Approach

Baumbach

Pfahler

Pozza

et al. 2020

JCM

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“…Apart from the characteristic symptoms of fever, pallor, bleeding tendency, hepatomegaly, and splenomegaly, there are a number of unusual clinical manifestations including musculoskeletal (MSK) symptoms [ 3 ]. MSK involvement has been reported in childhood leukemia at rates varying from 7.1 to 62.3% [ 4 – 12 ]. In 2016, a systematic review and meta-analysis reported that MSK symptoms were a prominent clinical presenting feature in childhood leukemia, including limb pain (43%), bone pain (26%), joint pain (15%), and limping (11%) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…For example, in some studies, MSK involvement was found to be more frequent in acute lymphoblastic leukemia (ALL), especially B-cell ALL, than acute myeloid leukemia (AML) [ 13 – 15 ]. This subgroup with MSK involvement also had lower rates of hematologic abnormalities, as well as peripheral blast counts at initial presentation [ 12 – 16 ]. Therefore, childhood leukemia with MSK involvement can mimic rheumatic or orthopedic conditions and lead to delayed diagnosis of leukemia [ 14 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal involvement in childhood leukemia: Characteristics and survival outcomes

et al. 2022

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Background Childhood leukemia with musculoskeletal (MSK) involvement mimics various conditions, which consequently leads to diagnostic delays. The clinical implication of MSK involvement in this disease on survival outcomes is inconclusive. This study aimed to compare characteristics and survival outcomes between MSK and non-MSK involvement in childhood leukemia. Methods The medical records of children newly diagnosed with acute leukemia of an age under 15 years were retrospectively reviewed. Two-to-one nearest-neighbor propensity score-matching was performed to obtain matched groups with and without MSK involvement. The Kaplan–Meier method and log-rank test were then used to assess the effect of MSK involvement on survival outcomes. Results Of 1042 childhood leukemia cases, 81 (7.8%) children had MSK involvement at initial presentation. MSK involvement was more likely in children with acute lymphoblastic leukemia than acute myeloid leukemia (p < 0.05). Hematologic abnormalities were less frequent in the MSK involvement group (p < 0.05). The absence of peripheral blast cells was significantly higher in the MSK involvement group (17.3% vs 9.6%, p = 0.04). Normal complete blood counts with absence of peripheral blast cells were found 2.5% of the children with MSK involvement. By propensity score-matching for comparable risk groups of children with and without MSK involvement, the 5-year overall survival was not significantly different (48.2% vs 57.4%, respectively, p = 0.22), nor was event-free survival (43.3% vs 51.8%, respectively, p = 0.31). Conclusion Childhood leukemia with MSK involvement had the characteristics of minimal or absent hematologic abnormalities and peripheral blast counts.

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“…In fact, bone pain or radiographic abnormalities can be very frequent at presentation in cases of acute lymphoblastic leukemia (ALL) [3]. On the other hand, bone involvement on initial presentation is extremely rare in AML, and only six such cases have been reported in patients below the age of 15 years (Table 1) [4][5][6][7][8]. Bone pain in AL is caused by the proliferation of leukemic cells in the bone marrow and pressure effects within the medullary canal and under the periosteum [9].…”

Section: Discussionmentioning

confidence: 99%

Humeral Diaphyseal Osteolytic Lesion as the Initial Presentation of Acute Myeloid Leukemia in a Child: A Case Report and Review of the Literature

Goto¹,

Iwata²,

Nozawa³

et al. 2022

Cureus

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It is well known that acute myeloid leukemia (AML) is characterized by lethargy, fever, pallor, and purpura. In children, however, skeletal symptoms may be present at onset in rare cases, and such cases tend to be misdiagnosed as osteomyelitis or septic arthritis. To distinguish acute leukemia from osteomyelitis or bone tumor, the utility of magnetic resonance imaging (MRI) has been discussed. We present a pediatric case of AML in which the initial manifestation was pain in a single bone, and the diagnosis was aided by bone marrow examination and MRI. A one-year-old male with AML presented with left humeral bone pain and intermittent fever. T1-weighted magnetic resonance imaging (T1WI) revealed diffuse low signal intensity in the bone marrow adjacent to the localized musculoskeletal symptoms. Despite a lack of blasts in the peripheral blood, the histopathological features of the bone focus suggested the need for an iliac crest bone marrow biopsy to obtain a definitive diagnosis. After the diagnosis of AML, the patient received induction and consolidation chemotherapy. He is currently alive in remission after a post-diagnosis follow-up of 36 months. To date, only seven pediatric cases of AML with skeletal symptoms at initial presentation have been reported, including the present one. In three cases, the skeletal lesion was observed at a single site, and the initial misdiagnosis was discitis, septic arthritis, or acute osteomyelitis. We suggest that AML should be considered as a differential diagnosis in children presenting with treatment-resistant single skeletal lesions. Not only MRI but also bone biopsy can yield diagnostically important information.

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Difficulty in the diagnosis of bone and joint pain associated with pediatric acute leukemia; comparison with juvenile idiopathic arthritis

Abstract: Leukemia-associated osteoarthralgia is often indistinguishable from rheumatic diseases by imaging and laboratory findings and should be confirmed by bone marrow examination.

Cited by 11 publications

References 16 publications

How We Manage Bone Marrow Edema—An Interdisciplinary Approach

How We Manage Bone Marrow Edema—An Interdisciplinary Approach

Musculoskeletal involvement in childhood leukemia: Characteristics and survival outcomes

Humeral Diaphyseal Osteolytic Lesion as the Initial Presentation of Acute Myeloid Leukemia in a Child: A Case Report and Review of the Literature

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