Osteoarticular Manifestations as Initial Presentation of Acute Leukemias in Children and Adolescents in Bahia, Brazil

Robazzi, Teresa Cristina Martins Vicente; Barreto, José Henrique Silva; Silva, Luciana Rodrígues; Santiago, Mittermayer Barreto; Mendonça, Núbia

doi:10.1097/mph.0b013e3181468c55

Cited by 32 publications

(22 citation statements)

References 23 publications

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“…But in contrast to other reports, only 20% of the newly diagnosed ALL patients had musculoskeletal symptoms, one third of them with accompanying general complaints. Fever, pallor, bone pain and night pain are the most likely symptoms of an underlying leukaemia [9,10]. Severe night-time pains that awaken a child are not typical for JIA and point towards malignant diseases [8].…”

Section: Discussionmentioning

confidence: 99%

Rheumatic symptoms in childhood leukaemia and lymphoma-a ten-year retrospective study

et al. 2013

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BackgroundThe initial symptoms of childhood leukaemia and lymphoma are often similar to those of juvenile idiopathic arthritis (JIA). In our study, we analyzed the frequency and characteristics of musculoskeletal complaints as the initial presenting symptoms of newly diagnosed leukaemia and lymphoma patients in the past 10 years in our clinic.MethodsUsing the Hungarian Tumour Register, we performed a retrospective analysis of the medical records of 166 new leukaemia and 95 new lymphoma pediatric patients treated from 1999 to 2009 at the 2nd. Dept. of Paediatrics of the Semmelweis University in Budapest.ResultsTwenty percent of the leukaemic (33 children) and 2% of the lymphoma patients (2 children) had musculoskeletal symptoms at first presentation. Two-thirds of both groups of patients had other general symptoms like fever and/or fatigue. The hip was the most frequently affected joint (7/33) in the leukaemic patients. Twenty-four percent of all the children had been previously evaluated by an orthopaedist; 12% had visited another rheumatologist prior to diagnosis. Imaging had been done in an unexpectedly low number of patients prior to referral to our unit (radiographs: 16 or 48%, ultrasound: 5 patients or 15%). Radiographs of the affected joints were abnormal in only one case (1/16, 6%). The joint ultrasound was abnormal in only three children of 5 studied (3/5, 60%). Anaemia (26/32, 6%), thrombocytopenia (78%) and LDH elevation (3–4 times the normal count) were frequent in the leukaemic patients. Half of the cases had a normal leukocyte count. The lymphoma group had similar results. Two patients of the leukaemia group received steroid treatment before the final diagnosis. Severe pain out of proportion to physical findings is another clue.ConclusionsHaematologic malignancies must be excluded before initiation of therapy for childhood arthritis among children presenting with musculoskeletal signs and symptoms, particularly in atypical cases. Malignancies are to be suspected when pain is disproportionately severe compared to the physical examination findings, and when anaemia, thrombocytopenia, and an elevated LDH level are present. Diagnosing leukaemia early is important because the use of steroids and immunosuppressive medications may mask and delay its diagnosis. Additionally, pre-treatment of presumed JIA patients with these drugs who eventually are diagnosed to have a malignancy may lead to the malignancy being steroid-resistant and more difficult to treat.

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Section: Discussionmentioning

confidence: 99%

Rheumatic symptoms in childhood leukaemia and lymphoma-a ten-year retrospective study

et al. 2013

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“…All had absence of blasts in peripheral smear which was similar to our case. Robazzi et al [11] observed arthritis in 26% occasions in a pool of 313 cases of ALL and it was mainly large joint arthritis. Marwaha et al has reported an incidence of 16% of small joints involvement in a recently published article.…”

Section: Discussionmentioning

confidence: 97%

“…Joint involvement as an initial presentation of acute leukemia in children has been described in literature [8][9][10][11]. About 15% to 30% of ALL patients manifest with osteoarthitic symptoms, some of which may mimic juvenile idiopathic arthritis (JIA) [11]. However, the interesting fact was that the arthritis here was transient and intermittent.…”

Section: Discussionmentioning

confidence: 99%

Bilateral nephromegaly and arthritis: A rare presentation of acute lymphoblastic leukemia

Sabui¹,

Sardar²,

Laha³

et al. 2013

OJPed

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“…It has been reported that childhood ALL can present with GI symptoms, such as diarrhea, but these are rarely documented and linked to ALL‐blast infiltration 10 . Even in cases of extensive leukemia infiltrates of liver/spleen/lungs, GI bleeding cannot be attributed to leukemia infiltrates but to the presence of non‐specific duodenal ulcers 11 .…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal presentation of late acute lymphoblastic leukemia relapse

Papadakis¹,

Roma

Stefanaki

et al. 2010

Pediatrics International

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Osteoarticular Manifestations as Initial Presentation of Acute Leukemias in Children and Adolescents in Bahia, Brazil

Abstract: AL should be considered on the differential diagnosis of osteoarticular symptoms of unknown etiology in children.

Cited by 32 publications

References 23 publications

Rheumatic symptoms in childhood leukaemia and lymphoma-a ten-year retrospective study

Rheumatic symptoms in childhood leukaemia and lymphoma-a ten-year retrospective study

Bilateral nephromegaly and arthritis: A rare presentation of acute lymphoblastic leukemia

Gastrointestinal presentation of late acute lymphoblastic leukemia relapse

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