Atypical presentation of high-grade non-Hodgkin lymphoma in a child: A diagnostic challenge

This case report describes an atypical presentation of high-grade Non-Hodgkin's Lymphoma (NHL) in a 10-year-old girl who presented to the emergency department with severe, unexplained flank pain and inability to walk, despite a lack of significant trauma history. Initial assessment revealed mild renal angle tenderness and a matted suprasternal lymph node, with laboratory results and preliminary imaging unremarkable. Persistent pain prompted advanced imaging, which identified a pathological spinal fracture and multiple masses consistent with aggressive NHL metastasis. Histopathological confirmation was achieved via lymph node biopsy. We highlight the diagnostic challenges posed by rare, atypical presentations of NHL in children, where symptoms may mimic benign conditions or minor trauma. Early suspicion and comprehensive diagnostic workup, including MRI and CT, were crucial for timely intervention. The patient was transferred to a pediatric oncology centre and achieved remission following chemotherapy. This report underscores the importance of maintaining a high index of suspicion for malignancy in children with unexplained pain or persistent symptoms, emphasizing the value of multidisciplinary collaboration and advanced imaging in early diagnosis.