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Malignancies in children who initially present with rheumatic complaints
1Division of Pediatric Rheumatology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
The Journal of Pediatrics
|January 8, 1999
Summary
Children with cancer are often misdiagnosed with rheumatic conditions. Key indicators of malignancy in pediatric rheumatology referrals include bone pain, severe symptoms, and atypical features, prompting reevaluation of rheumatic diagnoses.
Area of Science:
- Pediatric Rheumatology
- Pediatric Oncology
- Diagnostic Medicine
Background:
- Children with malignancy are frequently referred to pediatric rheumatology with provisional rheumatic diagnoses.
- Distinguishing malignancy from rheumatic disorders in children is a diagnostic challenge.
Purpose of the Study:
- To identify clinical and investigative features that differentiate malignancy from rheumatic diseases in pediatric referrals.
- To improve diagnostic accuracy for children presenting with rheumatic symptoms but having underlying cancer.
Main Methods:
- Retrospective review of 29 children diagnosed with malignancy referred to pediatric rheumatology centers.
- Analysis of presenting symptoms, physical findings, and initial investigations.
Main Results:
- Patients presented with rheumatic-like symptoms (musculoskeletal pain, fever, fatigue, arthritis).
- Malignancy indicators included nonarticular bone pain, significant back pain, bone tenderness, severe constitutional symptoms, and atypical features.
- Abnormal initial investigations (blood counts, ESR/platelet discordance, LDH, imaging) were common, but often unrecognized.
Conclusions:
- Diverse malignancies, beyond leukemia, can mimic pediatric rheumatic diseases.
- Pediatric care providers must recognize atypical rheumatic features and reevaluate diagnoses when malignancy is suspected.
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