Childhood acute lymphoblastic leukaemia masquerading as primary skeletal problem

Abstract

Acute lymphobiastic leukaemia (ALL) usually presents with signs of bone marrow failure, Occasionally ALL in children may present with non-specific or misleading clinical features. In a retrospect analysis of 25 consecutive cases of childhood ALL, we identified three children who were initially managed and discharged as acute osteomyelitis, juvenile chronic arthritis and postinfectious arthralgia respectively. They had mild normochromic, normocytic anaemia and two had transient leucopenia. Their platelet counts were normal and none had circulating blasts. The severity of their skeletal symptoms was out of proportion to the clinical and radiological finding. They failed to respond to the initial management and diagnosis was delayed for an average of 42 days and eventually confirmed on the marrow aspirate. Complete remission was attained in all cases with standard chemotherapy and had been maintained for an average of 29 months. ALL should be considered as a differential diagnosis in children complaining of multiple or persistent joint pains, especially in the presence of atypical clinical features or poor response to treatment.