Chronic recurrent multifocal osteomyelitis as the first presentation of acute lymphoblastic leukemia in a 2-year-old...

Area of Science:

• Pediatric Hematology
• Pediatric Oncology
• Pediatric Orthopedics

Background:

• Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disease in children.
• CRMO typically presents with localized bone pain and swelling.
• Distinguishing CRMO from other bone pathologies is crucial for appropriate management.

Observation:

• A 2-year-old boy presented with a 6-month history of chronic recurrent multifocal osteomyelitis.
• The patient exhibited bilateral, symmetric, and multifocal bone lesions.
• Initial complete blood count parameters and physical examination for hepatosplenomegaly were normal.

Findings:

• The patient was subsequently diagnosed with acute lymphoblastic leukemia (ALL).
• The presentation mimicked multifocal osteomyelitis, highlighting a rare overlap in clinical manifestations.
• Bone marrow aspiration revealed the underlying leukemia.

Implications:

• This case underscores the importance of considering leukemia in pediatric patients with unusual osteomyelitis presentations.
• Bone marrow aspiration should be considered in children with bilateral, symmetric, or multifocal bone lesions suggestive of osteomyelitis, irrespective of blood counts or hepatosplenomegaly.
• Early diagnosis of leukemia is critical for timely and effective treatment, improving patient outcomes.