Clues to remind leukemia in patients with arthritis: case presentations

Acute lymphocytic leukemia (ALL) may initially present with musculoskeletal symptoms such as pain or swelling, even before appearance of blasts in the peripheral blood. Fifteen to 30% of all ALL patients have musculoskeletal complaints at disease onset. Such presentation may lead to misdiagnosis of the patients causing a delay in proper management. Here, we present 5 patients who were referred to Pediatric Rheumatology Department for the evaluation of arthritis and were finally diagnosed as ALL (table 1).

Table 1 Five patients who were referred to Pediatric Rheumatology Department for the evalution of arthritis and were finall diagnosed as ALL

The peripheral blood changes were absent or subtle in these patients. Some clinical, laboratory, and radiological clues helped to establish the diagnosis of ALL. We aimed to discuss the usefulness of history, physical findings, and simple laboratory and radiographic tests in decision-making.