“Refuses to walk” as an ED presentation of acute childhood leukemia

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

“…Patients with leukemia may have constitutional symptoms as their major manifestations and, therefore, may also present the possible diagnosis of child abuse, rheumatic disorders [vasculitis, RF, juvenile idiopathic arthritis (JIA), systemic lupus erythematosus, dermatomyositis, reactive arthritis], infectious conditions (osteomyelitis, septic arthritis, infectious mononucleosis, acute infectious lymphocytosis, pertussis and parapertussis, or certain viral illnesses), other malignant processes (metastatic neuroblastoma, metastatic rhabdomyosarcoma, metastatic retinoblastoma, non-Hodgkin lymphoma, Langerhans cell histiocytosis, Ewing sarcoma, and osteosarcoma), and other bone disease as osteoid osteoma. [10][11][12] We evaluated 406 patients diagnosed with AL who have been treated at the ONCO, Bahia Oncology Society Ltda between January 1995 and December 2005. Most children had ALL (77.1%) and 22.9% had AML.…”

Bony presentations of childhood haematological malignancy to the emergency room

“…Mean time between disease onset and final diagnosis was 3.2 months 16 to 5 months 17 . The most common presenting feature was monoarthritis involving larger joints 17,18 . Juvenile idiopathic arthritis was the most frequent provisional diagnosis 16,17 …”

“…‘Refusals to walk’, ‘septic arthritis’ and ‘acute arthritis’ as presentations of childhood haematological malignancy have been reported 18–20 …”

“…17 The most common presenting feature was monoarthritis involving larger joints. 17,18 Juvenile idiopathic arthritis was the most frequent provisional diagnosis. 16,17 Common misdiagnoses 'Refusals to walk', 'septic arthritis' and 'acute arthritis' as presentations of childhood haematological malignancy have been reported.…”

“…16,17 Common misdiagnoses 'Refusals to walk', 'septic arthritis' and 'acute arthritis' as presentations of childhood haematological malignancy have been reported. [18][19][20] We highlight a case of childhood haematological malignancy misdiagnosed as pulled elbow at first bony complaint to the ER. It was a 4-year-old Indian boy, who re-presented 2 days later to the ER with fever and pain over the same elbow.…”