Abstract
Some children with malignancy (e.g. acute lymphoblastic leukemia) who initially present with musculoskeletal complaints may be misdiagnosed as having a rheumatological disorder. In the literature, importance has been given to subtle changes in blood counts, which may point toward an underlying malignancy. We report 3 children with malignancy, who had an arthritic presentation but had normal blood counts at presentation. Atypical clinical pattern, significant nocturnal pain, pain out of proportion to joint involvement and prominent systemic features in these children prompted us to do a bone marrow examination that revealed a malignancy. Pediatricians must be aware of the arthritic presentation of childhood malignancy. If the clinical features point toward a malignancy, bone marrow examination should always be performed even if the blood counts are normal.
This is a preview of subscription content, log in via an institution to check access.
References
Bradlow A, Barton C (1991) Arthritic presentation of childhood leukaemia. Postgrad Med J 67:562–564
Trapani S, Grisolia F, Simonini G, Calabri GB, Falcini F (2000) Incidence of occult cancer in children presenting with musculoskeletal symptoms: a 10 years survey in a pediatric rheumatological unit. Semin Arthritis Rheum 29(6):348–359
Gupta D, Singh S, Suri D, Ahluwalia J, Das R, Varma N (2010) Arthritic presentation of acute leukemia in children: experience from a tertiary care centre in North India. Rheumatol Int 30:767–770
Jones OY, Spencer CH, Bowyer SL, Dent PB, Gottlieb B, Rabinovich CE (2006) A multicentric case control study on predictive factors distinguishing childhood leukaemia from juvenile rheumatoid arthritis. Pediatrics 117:e840–e844
Ostrov BE, Gold smith DP, Atherya BH (1993) Differentiation of systemic juvenile rheumatoid arthritis from acute leukaemia near the onset of disease. J Pediatr 122:595–598
Jonsson OG, Sartain P, Ducore JM, Buchanan GR (1990) Bone pain as an initial symptom of childhood acute lymphoblastic leukaemia: association with nearly normal hematological indexes. J Pediatr 117: 233–237
Cabral DA, Tucker LB (1999) Malignancies in children who initially present with rheumatic complaints. J Pediatr 134:53–57
Cassidy JT, Petty RE (2005) Chronic arthritis in childhood. In: Cassidy JT, Petty RE, Laxer RM, Lindsley CB (eds) Textbook of Pediatric Rheumatology, 5th edn. Elsevier Saunders, Philadelphia, pp 206–207
Schaller J (1972) Arthritis as a presenting manifestation of malignancy in children. J Pediatr 81:793–797
Spilberg I, Meyer GJ (1972) The arthritis of leukemia. Arthritis Rheum 15:630–635
Cassidy JT, Petty RE (2005) Skeletal malignancies and related disorders. In: Cassidy JT, Petty RE, Laxer RM, Lindsley CB (eds) Textbook of pediatric rheumatology, 5th edn. Elsevier Saunders, Philadelphia, pp 739–740
Pui CH, Crist WM (2006) Acute lymphoblastic leukemia. In: Pui CH (ed) Childhood leukemias, 1st edn. Cambridge University Press, Cambridge, pp 288–312
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Suri, D., Ahluwalia, J., Sachdeva, M.U.S. et al. Arthritic presentation of childhood malignancy: beware of normal blood counts. Rheumatol Int 31, 827–829 (2011). https://doi.org/10.1007/s00296-010-1584-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-010-1584-1