Bone marrow necrosis foreshadowing acute lymphoid leukemia

Necrosis of the bone marrow is rarely observed during life. Less than 50 cases have been reported, for the most part in patients with leukemia. The finding of bone marrow necrosis in children is even more rare. Of the seven cases reported, six patients had acute lymphoid leukemia and one patient had lymphocytic lymphoma. The occurrence of marrow necrosis diagnosed by aspirate and by biopsy in a child 18 months of age is presented. The necrosis was present several months before the appearance of acute lymphoid leukemia. The reasons for the presumed rarity of this pathological finding, its relationship with bone or joint pain and fever, hypotheses concerning pathogenesis, and its prognostic value are discussed.