Osteoporosis resulting from acute lymphoblastic leukemia in a 7-year-old boy: a case report

Abstract

IntroductionOsteoporosis in children is rare and usually secondary to an underlying disease process whose diagnosis may be difficult to detect. Etiological factors responsible for osteoporosis secondary to chronic illness include immobility, pubertal delay and other hormonal disturbances. Rarely, it can be a manifestation of acute lymphoblastic leukemia. Most of the reported bone fracture incidences associated with acute lymphoblastic leukemia occur during the course of the chemotherapy, not at the point of the first symptoms of leukemic disease, as happened with the case presented here.Case presentationA 7-year-old Asian Balinese boy presented with back pain. His anteroposterior pelvic radiograph showed osteoporotic bone. A bone age study revealed growth failure of his metacarpals, phalanges and sesamoid. His total bone mass density was 97% age-match. However, a peripheral blood smear showed normochromic anemia with thrombocytopenia. Immunophenotyping of his peripheral blood revealed no dominant markers, but a bone marrow aspiration confirmed a diagnosis of acute lymphoblastic leukemia.ConclusionsOsteoporosis was the only manifestation of the child’s underlying acute lymphoblastic leukemia. Leukemia was diagnosed when his bone marrow was found to contain more than 25% blasts. Because of leucopenia, the immunophenotype failed to reveal a dominant marker in this case, thus we were unable to classify the acute lymphoblastic leukemia.

Back pain: An unusual manifestation of acute lymphoblastic leukemia – A case report and review of literature

“…Characteristic findings of this rare primary manifestation of leukemia are lack of significant organomegaly or lymphadenopathy, normal or low white blood cell count with predominance of lymphocytes and rarely circulating lymphoblasts, normal platelet count, uric acid, and LDH values. [ 8 ]…”

Are Survivors of Childhood Acute Lymphoblastic Leukemia at Increased Risk for Low Bone Mass?

“…Firstly, pain in the bones or joints is one of the important initial symptoms of the disease. Moreover, low bone mass might be the only manifestation of underlying childhood ALL [22]. Throughout chemotherapy, Avascular Necrosis (AVN) is a disabling complication in children and adolescents, especially secondary to steroids [23].…”

Clinical Masks of Acute Leukemia in Children

“…In spite of this, Riccio I, Marcarelli M. [7] showed that musculoskeletal problems in pediatric acute leukemia was observed in 22% of children, this variant of manifestation ~ 12 ~ ISSN 2409-9988 most frequently results in diagnostic difficulties [8,9,10].…”