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SUMMARY: Öztürkmen S, Akyay A, Biçakçi Z, Karakoç Y, Arikan SM, Çelebi-Tayfur A, Agladioglu S, Olcay L. Delayed diagnosis of acute leukemia in a patient with bone pain and fracture. Turk J Pediatr 2010; 52: 552-555.
In childhood acute lymphoblastic leukemia (ALL), non-hematological manifestations involving the musculoskeletal system can also be encountered. These manifestations may cause a delay in the diagnosis of leukemia. The presented case in this report is a six-year-old boy who developed bone pain and long bone fracture and was diagnosed as ALL after a considerable delay. This case is presented to draw attention to the fact that leukemia must be considered in pediatric patients who present with bone manifestations.
Key words: children, leukemia, bone involvement.
The most common childhood cancer is acute lymphoblastic leukemia (ALL), accounting for about 33% of all pediatric malignancies1. Common clinical presentations of leukemia include anorexia, fatigue, fever, pallor, purpura, hepatosplenomegaly, lymphadenopathy, anemia, neutropenia, lymphocytosis, and thrombocytopenia2-3. These symptoms are frequently accompanied by musculoskeletal signs, such as limping, joint and bone pain4 and radiographic abnormalities, at presentation. However, it is a fact that the diagnosis of patients with leukemia who present with mainly musculoskeletal findings may be considerably delayed due to the work-up of these symptoms, which are also within the scope of orthopedics and physiotherapists.
Bone fracture, as a presenting symptom of childhood ALL, has been reported at diagnosis, and during and following treatment, with incidence rates ranging from 10% to 40%5. Fractures mostly involve the spine, associated with osteoporosis, with occasional peripheral locations2. Herein, we report a six-year-old boy with ALL whose diagnosis was delayed as long as two months because the presenting symptoms were bone pain and long bone fracture.
Case Report
A six-year-old boy with diffuse bone pain, coexistent fracture of the left distal radius and inability to walk was referred to our hospital because of malaise and pallor. It was learned that the diffuse, continuous bone pain, which was not disabling, had started two months before and increased progressively. A few weeks after its initiation, a fissure on his right elbow developed after a minimal trauma due to a fall while walking and a plaster cast was applied. One month later, a transverse fracture (Fig. 1) occurred on his left...