Acute lymphoblastic leukaemia presenting as chronic recurrent multifocal osteomyelitis

Area of Science:

• Pediatric Rheumatology
• Pediatric Hematology-Oncology

Background:

• Musculoskeletal symptoms like fever and joint swelling are common in children.
• Differential diagnoses for these symptoms can include inflammatory conditions and infections.
• Acute lymphoblastic leukemia (ALL) can sometimes present with non-specific symptoms mimicking other diseases.

Purpose of the Study:

• To report a rare case of acute lymphoblastic leukemia presenting with initial symptoms suggestive of chronic recurrent multifocal osteomyelitis.
• To emphasize the importance of considering hematologic malignancies in the differential diagnosis of pediatric musculoskeletal conditions.
• To highlight the challenges in early leukemia detection when symptoms overlap with other pediatric diseases.

Main Methods:

• Case report of a pre-schooler with prolonged fever and joint swelling.
• Initial investigations included bone marrow biopsy and exclusion of malignancy.
• Diagnosis evolved from suspected osteomyelitis/juvenile idiopathic arthritis to chronic recurrent multifocal osteomyelitis, and finally to acute lymphoblastic leukemia.

Main Results:

• The child initially presented with symptoms mimicking chronic recurrent multifocal osteomyelitis.
• Despite anti-inflammatory treatment for presumed osteomyelitis, the child developed pancytopenia and hepatosplenomegaly.
• Subsequent bone marrow biopsy confirmed acute lymphoblastic leukemia.

Conclusions:

• Children presenting with persistent musculoskeletal symptoms require a high index of suspicion for underlying hematologic malignancies.
• Early and accurate diagnosis of acute lymphoblastic leukemia is critical for timely intervention and improved patient outcomes.
• This case underscores the diagnostic challenges and the need for a vigilant approach in pediatric hematology-oncology and rheumatology.