Prolonged lumbosacral pain as the initial presentation in acute lymphoblastic leukemia in an adult

Abstract

Rationale: The differential diagnosis of conditions manifesting as bone and joint pain is complex. Although many individuals with acute leukemia experience bone pain, lumbosacral pain as an early feature of acute lymphoblastic leukemia (ALL) is rare. Patient concerns: Here we report a case of an adult who presented with a 7-month history of persistent lumbosacral pain which had become more severe during the previous month. Diagnoses: Prior to referral, his full blood count revealed no abnormalities, and a computerized tomography scan revealed mild bone hyperplasia of his lumbar vertebrae, with disc herniations of L3–S1. His blood biochemistry and urinary test results had been normal. After referral to our clinic, tests of the morphology, immunology, cytogenetics, and molecular biology of his bone marrow led to a diagnosis of MLL-AF4 fusion positive B-cell ALL. Interventions: Prior to his referral, he had been treated with painkillers by local doctors. The painkillers initially provided pain relief, but their effect wore off over time. After diagnosis, he was started on an adult ALL chemotherapy protocol. Outcomes: His symptoms resolved within a week of starting chemotherapy. At his most recent assessment, 10 months after diagnosis, he was on maintenance chemotherapy and in remission. Lessons: This case illustrates that prolonged lumbosacral pain may be a symptom of a life-threatening condition, rather than only attributable to chronic inflammation or disk herniations. Therefore, clinicians need to pay attention to subtle differences in the clinical presentation of patients with lumbosacral pain.

Case report: BCR-ABL-positive acute lymphoblastic leukemia with bone destruction: a treatment dilemma

“…More than 20% of children with ALL have bone pain at the onset, higher than that in adults with ALL. However, multiple bone destruction is rare in both children and adults with ALL ( 4 , 9 , 10 ). Among adult malignant tumors, multiple bone destruction incidence is 27%–35% in lung cancer, 25%–30% in breast cancer, 7%–30% in multiple myeloma, < 10% in malignant lymphoma, and < 1% in leukemia ( 2 ).…”

“…They were negative for CD2, CD3, CD5, CD7, CD8, CD11b, CD13, CD14, CD15, CD16, CD20, CD33, CD56, CD64, and CD117, consistent with the immunophenotype of B-cell ALL. The karyotype was 76 (3n), XX, -Y, +2, +4, +6, -7, +8, t (9:22) (q34.1:q11.2), +13, -15, +16, +17, +20, +21, +22 ( 4 )/46, XY ( 5 ). Leukemia fusion gene detection revealed BCR-ABL1 (P190) positivity.…”

A Brief Review of the Progress of Research on Late Pain Care in Patients with Leukemia

“…Therefore, the patients can choose music by themselves, or the medical staff can designate certain types of music for the patients, so as to help the patients to relieve pain through the auxiliary effect of music. Some studies have found that in the process of using music for patients with advanced pain due to leukemia, music not only can reduce pain, but also can help patients to reduce anxiety and relieve depressive symptoms [17] . The analysis may be that music promotes the excitement of auditory pathway in the brain and inhibits the adjacent pain centers, thereby alleviating the pain in the patient.…”

Vertebral Compression Fractures—The First Manifestations in the Elderly Acute Lymphoblastic Leukemia

“…2 Clinical presentation of adults with ALL usually involves symptoms of lymphadenectasis, infections, anemia, pallor, bleeding, and bone pain. 3 Though vertebral compression fractures have been reported as initial signs of ALL in children [4][5][6] and middle-aged, [7][8][9] to the best of our knowledge, there have not been any previous reports of vertebral compression fractures as an initial manifestation of ALL in elderly people. Here, we reported on a case of elderly man in whom back pain associated with vertebral compression and collapse were presenting features of ALL.…”

“… 2 Clinical presentation of adults with ALL usually involves symptoms of lymphadenectasis, infections, anemia, pallor, bleeding, and bone pain. 3 …”