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A "SURFin' Leukemia": Acute Lymphoblastic Leukemia Masquerading as a Syndrome of Undifferentiated Recurrent Fever
Laura De Nardi1, Martina D'Agostin1, Samuele Naviglio2
1Department of Medical Surgical and Health Science, University of Trieste.
Insights
Pediatric periodic fever can be an early sign of acute lymphoblastic leukemia (ALL), not just autoinflammatory conditions. Early suspicion of ALL is crucial to avoid misdiagnosis in children presenting with recurrent fevers.
Area of Science:
- Pediatric Oncology
- Rheumatology
- Hematology
Background:
- Periodic fever is a common childhood symptom, often linked to autoinflammatory diseases.
- However, fever can also be an atypical presentation of pediatric malignancies.
Observation:
- A 3-year-old boy presented with a 4-month history of recurrent fevers and joint pain.
- These episodes were initially misdiagnosed as undifferentiated recurrent fever syndrome.
Findings:
- The child was diagnosed with acute lymphoblastic leukemia (ALL).
- This case highlights that ALL can rarely manifest with periodic fever as an initial symptom.
Implications:
- Healthcare providers should maintain a high index of suspicion for underlying malignancy in children with unexplained periodic fevers.
- Considering leukemia in the differential diagnosis can prevent diagnostic delays and improve patient outcomes.
Abstract:
Periodic fever is not uncommon in childhood and is often ascribed to autoinflammatory conditions; however, it may be present also in children with cancer. We here describe the case of a 3-year-old boy with acute lymphoblastic leukemia who initially presented with a 4-month history of recurrent, stereotyped episodes of fever and localized joint pain, separated by completely symptom-free intervals. These symptoms were initially interpreted as a possible syndrome of undifferentiated recurrent fever until more signs of leukemia became apparent. Our report confirms that acute lymphoblastic leukemia can rarely present with periodic fever, thus possibly leading to diagnostic errors unless a high index of suspicion is maintained.
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