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Marino A, Baldassarre P, Ferrigno C, Biuso A, Minutoli M, Baldo F, Costi S, Gattinara MV, Caporali RF, Chighizola CB. Pre-Rheumatology Referral Consultation and Investigation Pattern in Children with Joint Complaints: Focus on Juvenile Idiopathic Arthritis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:600. [PMID: 38790595 PMCID: PMC11120367 DOI: 10.3390/children11050600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
The diagnosis of juvenile idiopathic arthritis (JIA) is often entrusted to the pediatric rheumatologist specialist. Timely referral to a specialized center is crucial. This study aims to assess the consultation and investigation patterns of patients with joint complaints before rheumatology referral. This longitudinal cohort study included patients with joint complaints who were referred to the Pediatric Rheumatology Unit. The cohort included 301 patients (58% female), 50 of them (17%) diagnosed with JIA. Compared to patients with orthopedic conditions or functional diseases, JIA patients had seen more specialists (p < 0.01) and received a quicker diagnosis (p < 0.01). Patients with early JIA diagnosis (within 3 months from symptoms onset) were younger (8.46 vs. 11.5 years old; p = 0.04), more frequently female (78% vs. 47%, p = 0.03), and with higher erythrocyte sedimentation rate (ESR) values (37 vs. 9 mm/h; p = 0.02) than those diagnosed later. Patients with a late diagnosis of JIA had a significantly longer median time between the first healthcare visit and the PR referral (25 vs. 101 days; p < 0.01). The main contributor to diagnostic delay in JIA was the time required for PR referral after the first healthcare consult. Younger age, female sex, and higher ESR values were associated with earlier diagnosis of JIA.
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Affiliation(s)
- Achille Marino
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Paola Baldassarre
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Cristina Ferrigno
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Andrea Biuso
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Martina Minutoli
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Francesco Baldo
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Stefania Costi
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Maurizio Virgilio Gattinara
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Roberto Felice Caporali
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
- Department of Clinical Sciences and Community Health, Research Center for Pediatric and Adult Rheumatic Diseases (RECAP.RD), University of Milan, 20122 Milan, Italy
- Department of Rheumatology and Medical Sciences, ASST G. Pini-CTO, 20122 Milan, Italy
| | - Cecilia Beatrice Chighizola
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
- Department of Clinical Sciences and Community Health, Research Center for Pediatric and Adult Rheumatic Diseases (RECAP.RD), University of Milan, 20122 Milan, Italy
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Brix N, Glerup M, Foell D, Kessel C, Wittkowski H, Berntson L, Fasth A, Nielsen S, Nordal E, Rygg M, Hasle H, Herlin T. Inflammatory Biomarkers Can Differentiate Acute Lymphoblastic Leukemia with Arthropathy from Juvenile Idiopathic Arthritis Better Than Standard Blood Tests. J Pediatr 2023; 258:113406. [PMID: 37023943 DOI: 10.1016/j.jpeds.2023.113406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To evaluate the predictive value of biomarkers of inflammation like phagocyte-related S100 proteins and a panel of inflammatory cytokines in order to differentiate the child with acute lymphoblastic leukemia (ALL) from juvenile idiopathic arthritis (JIA). STUDY DESIGN In this cross-sectional study, we measured S100A9, S100A12, and 14 cytokines in serum from children with ALL (n = 150, including 27 with arthropathy) and JIA (n = 236). We constructed predictive models computing areas under the curve (AUC) as well as predicted probabilities in order to differentiate ALL from JIA. Logistic regression was used for predictions of ALL risk, considering the markers as the respective exposures. We performed internal validation using repeated 10-fold cross-validation and recalibration, adjusted for age. RESULTS In ALL, the levels of S100A9, S100A12, interleukin (IL)-1 beta, IL-4, IL-13, IL-17, matrix metalloproteinase-3, and myeloperoxidase were low compared with JIA (P < .001). IL-13 had an AUC of 100% (95% CI 100%-100%) due to no overlap between the serum levels in the 2 groups. Further, IL-4 and S100A9 had high predictive performance with AUCs of 99% (95% CI 97%-100%) and 98% (95% CI 94%-99%), respectively, exceeding both hemoglobin, platelets, C-reactive protein, and erythrocyte sedimentation rate. CONCLUSIONS The biomarkers S100A9, IL-4, and IL-13 might be valuable markers to differentiate ALL from JIA.
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Affiliation(s)
- Ninna Brix
- Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark.
| | - Mia Glerup
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University of Muenster, Muenster, Germany
| | - Christoph Kessel
- Department of Pediatric Rheumatology and Immunology, University of Muenster, Muenster, Germany
| | - Helmut Wittkowski
- Department of Pediatric Rheumatology and Immunology, University of Muenster, Muenster, Germany
| | - Lillemor Berntson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susan Nielsen
- Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ellen Nordal
- Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St Olavs Hospital, Trondheim, Norway
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Herlin
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
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3
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Cho S, Wurz A, Henry B, Tran A, Duong J, Noel M, Neville A, Patton M, Russell B, Giles J, Reynolds K, Schulte F. Exploring pain among young people who have completed treatment for acute lymphoblastic leukemia: experiences of youth and caregivers. Support Care Cancer 2023; 31:415. [PMID: 37354228 DOI: 10.1007/s00520-023-07888-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed among individuals <14 years of age. The disease and its treatments are associated with negative side effects, including pain, which is both prevalent and distressing. Little is known about pain experiences in this population, which has slowed efforts to identify strategies to mitigate and cope with this adverse effect. This study sought to explore youth's and their caregiver's experiences with, and perspectives of, pain in the context of pediatric cancer treatment. METHODS Youth and one of their caregivers were recruited through (omitted for peer review). Following completion of a demographic survey, youth and one of their caregivers were interviewed separately using a semi-structured, one-on-one interview guide. Demographic information was analyzed with descriptive statistics, and interviews were transcribed verbatim and analyzed using reflexive thematic analysis. RESULTS Youth (n = 19; Mage = 15.3 years) and caregiver (n = 19; Mage = 45.4 years) perspectives informed 4 themes: (1) my pain experience is nuanced, multidimensional, and is changing over time; (2) the cancer experience has changed the way I experience and respond to pain; (3) I used strategies to manage pain, and not all of them worked; and (4) my pain experience was influenced by people around me. CONCLUSIONS Findings extend prior work, suggesting that pain is common, distressing, multidimensional, and influenced by social context. Results highlight the number of ways in which youth and their caregivers attempt to manage their pain and factors influencing pain experiences. Greater efforts are needed to address pain during cancer treatment and survivorship.
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Affiliation(s)
- Sara Cho
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Fraser Valley, BC, Canada
| | - Brianna Henry
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Andrew Tran
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jenny Duong
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Alexandra Neville
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Michaela Patton
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Brooke Russell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jennifer Giles
- Alberta Children's Hospital, Haematology, Oncology, and Transplant Program, Calgary, AB, Canada
| | - Kathleen Reynolds
- Alberta Children's Hospital, Haematology, Oncology, and Transplant Program, Calgary, AB, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Civino A, Bovis F, Ponzano M, Alighieri G, Prete E, Sorrentino S, Magni-Manzoni S, Vinti L, Romano M, Santoro N, Filocamo G, Belotti T, Santarelli F, Gorio C, Cattalini M, Stabile G, Conter V, Rondelli R, Pession A, Ravelli A. Development and Initial Validation of the ONCOREUM Score to Differentiate Childhood Cancer with Arthropathy from Juvenile Idiopathic Arthritis. J Pediatr 2023; 253:219-224.e3. [PMID: 36202241 DOI: 10.1016/j.jpeds.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop and validate a weighted score, the ONCOREUM score, that aids physicians in differentiation of cancer with arthropathy from juvenile idiopathic arthritis (JIA). STUDY DESIGN Data were extracted from the ONCOREUM Study, a multicenter, cross-sectional investigation aimed at comparing children with cancer and arthropathy to children with JIA. Three statistical approaches were applied to develop the ONCOREUM score and assess the role of each variable in the diagnosis of cancer with arthropathy, including 2 approaches based on multivariable stepwise selection (models 1 and 2) and 1 approach on a Bayesian model averaging method (model 3). The β coefficients estimated in the models were used to assign score points. Considering that not missing a child with cancer is a mandatory clinical objective, discriminating performance was assessed by fixing sensitivity at 100%. Score performance was evaluated in both developmental and validation samples (representing 80% and 20% of the study population, respectively). RESULTS Patients with cancer and arthropathy (49 with solid tumors and 46 with hematologic malignancies without peripheral blasts) and 677 patients with JIA were included. The highest area under the receiver operating characteristic (ROC) curve (AUC) in the validation data set was yielded by model 1, which was selected to constitute the ONCOREUM score. The score ranged from -18 to 21.8, and the optimal cutoff obtained through ROC analysis was -6. The sensitivity, specificity, and AUC of the cutoff in the validation sample were 100%, 70%, and 0.85, respectively. CONCLUSIONS The ONCOREUM score is a powerful and easily applicable tool that may facilitate early differentiation of malignancies with articular complaints from JIA.
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Affiliation(s)
- Adele Civino
- Pediatric Rheumatology and Immunology, Hospital "Vito Fazzi", Lecce, Italy.
| | - Francesca Bovis
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Italy
| | - Giovanni Alighieri
- Neonatology and Neonatal Intensive Care Unit, Hospital "A. Perrino", Brindisi, Italy
| | - Eleonora Prete
- Department of Hematology and Bone Marrow Transplant, Hospital "Card. G. Panico", Tricase, Italy
| | - Stefania Sorrentino
- Department of Paediatric Haemato-Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Giannina Gaslini Institute, Genoa, Italy
| | | | - Luciana Vinti
- Department of Pediatric Hemato-Oncology, IRCCS Bambino Gesù, Rome, Italy
| | - Micol Romano
- Paediatric Rheumatology, Hospital and Orthopaedic Trauma Centre "G. Pini", Milan, Italy
| | - Nicola Santoro
- Department of Pediatric Oncology and Hematology, University "Aldo Moro" Bari, Italy
| | - Giovanni Filocamo
- Pediatric Rheumatology, IRCCS Ca' Granda Maggiore Hospital, Milan, Italy
| | - Tamara Belotti
- Pediatric Oncology and Haematology Unit, IRCCS, University of Bologna, Italy
| | - Francesca Santarelli
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, "Regina Margherita" Children Hospital, University of Turin, Italy
| | - Chiara Gorio
- Pediatric Oncohematology and Bone Marrow Transplant Unit, University of Brescia and "Spedali Civili", Brescia, Italy
| | - Marco Cattalini
- Pediatric Clinic, University of Brescia and "Spedali Civili", Brescia, Italy
| | - Giulia Stabile
- CINECA Interuniversity Consortium, Casalecchio di Reno, Italy
| | - Valentino Conter
- Pediatric Hematology-Oncology Unit, University of Milano-Bicocca, Monza, Italy
| | - Roberto Rondelli
- Pediatric Oncology and Haematology Unit, IRCCS, University of Bologna, Italy
| | - Andrea Pession
- Pediatric Unit, IRCCS S.Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Angelo Ravelli
- Scientific Director, Giannina Gaslini Institute, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DiNOGMI), University of Genoa, Italy
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5
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Peripheral Bone Relapse of Paediatric TCF3-HLF Positive Acute Lymphoblastic Leukaemia during Haematopoietic Stem Cell Transplantation: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121919. [PMID: 36553362 PMCID: PMC9777522 DOI: 10.3390/children9121919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
The present case report features a highly uncommon form of a paediatric TCF3-HLF positive acute lymphoblastic leukaemia (ALL) relapse, an extramedullary, peripheral bone manifestation. Following complete remission, during the conditioning for haematopoietic stem cell transplantation (HSCT), our sixteen-year-old male patient complained of fever, pain and swelling of the right forearm. Radiography suggested acute osteomyelitis in the right ulna with subsequent surgical confirmation. Intraoperatively obtained debris culture grew Staphylococcus aureus and Acinetobacter pittii. Measures taken to control the infection were deemed to be successful. However, after the completion of the otherwise uneventful HSCT, a very early medullary relapse was diagnosed. Revising the original surgical samples from the ulna, bone relapse of ALL was immunohistochemically confirmed. Reviewing the previous cases found in the literature, it is advised to consider uncommon forms of ALL relapse when encountering ambiguous cases of osteomyelitis or arthritis during haematological remission.
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Kittivisuit S, Sripornsawan P, Songthawee N, Chavananon S, McNeil EB, Chotsampancharoen T. Musculoskeletal involvement in childhood leukemia: Characteristics and survival outcomes. Pediatr Rheumatol Online J 2022; 20:34. [PMID: 35501817 PMCID: PMC9063147 DOI: 10.1186/s12969-022-00692-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED BACKGROUND : Childhood leukemia with musculoskeletal (MSK) involvement mimics various conditions, which consequently leads to diagnostic delays. The clinical implication of MSK involvement in this disease on survival outcomes is inconclusive. This study aimed to compare characteristics and survival outcomes between MSK and non-MSK involvement in childhood leukemia. METHODS The medical records of children newly diagnosed with acute leukemia of an age under 15 years were retrospectively reviewed. Two-to-one nearest-neighbor propensity score-matching was performed to obtain matched groups with and without MSK involvement. The Kaplan-Meier method and log-rank test were then used to assess the effect of MSK involvement on survival outcomes. RESULTS Of 1042 childhood leukemia cases, 81 (7.8%) children had MSK involvement at initial presentation. MSK involvement was more likely in children with acute lymphoblastic leukemia than acute myeloid leukemia (p < 0.05). Hematologic abnormalities were less frequent in the MSK involvement group (p < 0.05). The absence of peripheral blast cells was significantly higher in the MSK involvement group (17.3% vs 9.6%, p = 0.04). Normal complete blood counts with absence of peripheral blast cells were found 2.5% of the children with MSK involvement. By propensity score-matching for comparable risk groups of children with and without MSK involvement, the 5-year overall survival was not significantly different (48.2% vs 57.4%, respectively, p = 0.22), nor was event-free survival (43.3% vs 51.8%, respectively, p = 0.31). CONCLUSION Childhood leukemia with MSK involvement had the characteristics of minimal or absent hematologic abnormalities and peripheral blast counts.
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Affiliation(s)
- Sirinthip Kittivisuit
- grid.7130.50000 0004 0470 1162Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Pornpun Sripornsawan
- grid.7130.50000 0004 0470 1162Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Natsaruth Songthawee
- grid.7130.50000 0004 0470 1162Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Shevachut Chavananon
- grid.7130.50000 0004 0470 1162Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Edward B. McNeil
- grid.7130.50000 0004 0470 1162Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Gkoudina A, Gekas C, Polydorides M, Graikos G, Papakonstantinou E, Saloupis P. Pediatric Leukemia From an Orthopedic Perspective: A Case of Acute Lymphoblastic Leukemia Initially Managed as Septic Hip With Osteomyelitis. Cureus 2022; 14:e24103. [PMID: 35573545 PMCID: PMC9106539 DOI: 10.7759/cureus.24103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) represents the most common pediatric cancer accounting for about one-third of all malignancies in childhood. The differential diagnosis for a pediatric patient manifesting with joint pain and refusal to bear weight is wide and includes trauma, transient synovitis, septic arthritis, rheumatologic disorders, and malignancy. Overt complaints from the musculoskeletal system as the initial manifestation of ALL may present in up to 30% of cases with normal laboratory tests and without hepatosplenomegaly or lymphadenopathy, perplexing the establishment of a definite diagnosis. Herein, we report the case of a three-year-old male who presented with recurrent hip pain and fever masquerading as septic arthritis recalcitrant to intravenous (IV) antibiotics, irrigation, and debridement of the hip joint with a final diagnosis of acute lymphoblastic leukemia confirmed by bone marrow biopsy.
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8
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Habib MB, Tannos B, Abdelrazek M, Yassin MA. Acute lymphoblastic leukemia presenting with limping in a young adult. Clin Case Rep 2022; 10:e05426. [PMID: 35228876 PMCID: PMC8864571 DOI: 10.1002/ccr3.5426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
Acute lymphoblastic leukemia is one of the rare malignancies in adult. We report a 29‐year‐old man presented with progressive limping followed a chronic back pain. Imaging showed reduced vertebral body height and diffuse lytic skeletal infiltration. Bone marrow aspiration confirmed B‐acute lymphoblastic leukemia/lymphoma, and the patient was treated with chemotherapy.
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Affiliation(s)
- Mhd Baraa Habib
- Internal Medicine Department Hamad Medical Corporation Doha Qatar
| | - Bashar Tannos
- Internal Medicine Department Hamad Medical Corporation Doha Qatar
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Royle LN, Muthee BW, Rosenbaum DG. Inflammatory conditions of the pediatric hand and non-inflammatory mimics. Pediatr Radiol 2022; 52:104-121. [PMID: 34415360 DOI: 10.1007/s00247-021-05162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/18/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
Hand involvement can assume an outsized role in the perception and presentation of disease as a result of functional impairment, visual conspicuity and susceptibility to early structural damage. Rheumatologic referral for inflammatory conditions can be delayed because of assumptions of a traumatic, infectious or neoplastic etiology; conversely, initial rheumatologic evaluation might be pursued for many of the same non-inflammatory causes. This pictorial essay highlights inflammatory conditions affecting the pediatric hand, including juvenile idiopathic arthritis, infectious arthritis, systemic connective tissue disorders, and a variety of less common inflammatory diseases, as well as non-inflammatory congenital, vascular, neoplastic and metabolic differential considerations.
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Affiliation(s)
- Leanne N Royle
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Bernadette W Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Daniel G Rosenbaum
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada.
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10
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Ito A, Osumi T, Fujimori K, Tomizawa D, Kato M, Tsuji S, Matsumoto K, Ishiguro A, Miyazaki O. Utility of emergent plain X-ray for childhood acute leukemia with bone pain. Pediatr Int 2022; 64:e14843. [PMID: 33998750 DOI: 10.1111/ped.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/08/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to evaluate the utility of plain X-ray radiograph (PXR) findings in suggesting a diagnosis of acute leukemia in children presenting with bone pain in the emergency department (ED) of a children's hospital. METHODS Using our radiology reporting system and registered data for childhood acute leukemia, we collected data regarding patients who underwent musculoskeletal PXR examinations in the ED due to bone pain in their extremities, from March 1, 2002 to June 30, 2015. We retrospectively reviewed their PXR findings and clinical information from the electronic medical records. RESULTS A total of 1,331 patients underwent PXR examinations and in 12 PXR findings showed suspected acute leukemia. From the registered data we found 12 acute leukemia patients who underwent emergency extremity PXR. Ten patients were finally confirmed to have acute leukemia by bone marrow examinations. The most common finding was lucent metaphyseal bands, demonstrated in seven cases, whereas six patients did not show any abnormalities in their peripheral blood cell counts. Sensitivity and specificity values of PXR for acute leukemia diagnosis were 90.0% and 99.8%, respectively. Positive predictive value and negative predictive values were 75.0% and 99.9%, respectively. CONCLUSIONS Plain X-ray radiograph is a useful diagnostic tool to detect possible acute leukemia in patients presenting with bone pain, earlier than abnormalities of their peripheral blood cell counts. Our results implied the possibility of re-examining PXRs in acute leukemia more carefully, even when there are no abnormalities in blood cell counts.
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Affiliation(s)
- Ai Ito
- Children's Cancer Center National Center for Child Health and Development (NCCHD), Tokyo, Japan.,Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan
| | - Tomoo Osumi
- Children's Cancer Center National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Kentaro Fujimori
- Children's Cancer Center National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Daisuke Tomizawa
- Children's Cancer Center National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Motohiro Kato
- Children's Cancer Center National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Satoshi Tsuji
- Division of Pediatric Emergency and Transport Services, NCCHD, Tokyo, Japan
| | - Kimikazu Matsumoto
- Children's Cancer Center National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Akira Ishiguro
- Children's Cancer Center National Center for Child Health and Development (NCCHD), Tokyo, Japan.,Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan
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Diagnosis and Management of Osteomyelitis in Children. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Utility of 18F-FDG-PET for detecting acute lymphoblastic leukemia: a case series of pediatric acute lymphoblastic leukemia without hematological symptoms. Int J Hematol 2021; 115:287-292. [PMID: 34643875 DOI: 10.1007/s12185-021-03232-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
Acute leukemia is typically diagnosed from presenting features related to hematological symptoms, but certain patients present with prominent musculoskeletal pain without signs of hematological abnormality. We reviewed the medical records of 58 children diagnosed with acute lymphoblastic leukemia (ALL) at our hospital to evaluate initial features. Forty six of these patients had hematological symptoms, anemia, or hemorrhage (Group H), while 12 patients had prominent musculoskeletal pain without hematological symptoms (Group P). Diagnosis of leukemia took significantly more time for those 12 patients (Group H, 17.1 days; Group P, 48.5 days). In three of the 12 patients in Group P, localized abnormal imaging findings and unremarkable blood test results led to initial diagnoses of chronic recurrent multifocal osteomyelitis, bone fracture, and septic osteomyelitis. However, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) revealed multiple intense bone foci or systemic bone marrow uptake, leading to the diagnosis of ALL. A review of 18F-FDG-PET results from 23 patients with ALL who underwent a PET scan (Group H, n = 15; Group P, n = 8) showed multiple bone foci or systemic bone marrow uptake in all cases. In conclusion, lack of hematological symptoms in ALL patients can delay diagnosis, and 18F-FDG-PET is useful for diagnosing leukemia in such cases.
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Civino A, Alighieri G, Prete E, Caroleo AM, Magni-Manzoni S, Vinti L, Romano M, Santoro N, Filocamo G, Belotti T, Santarelli F, Gorio C, Ricci F, Colombini A, Pastore S, Cesaro S, Barone P, Verzegnassi F, Olivieri AN, Ficara M, Miniaci A, Russo G, Gallizzi R, Pericoli R, Breda L, Mura R, Podda RA, Onofrillo D, Lattanzi B, Tirtei E, Maggio MC, De Santis R, Consolini R, Arlotta A, La Torre F, Mainardi C, Pelagatti MA, Coassin E, Capolsini I, Burnelli R, Tornesello A, Soscia F, De Fanti A, Rigante D, Pizzato C, De Fusco C, Abate ME, Roncadori A, Rossi E, Stabile G, Biondi A, Lepore L, Conter V, Rondelli R, Pession A, Ravelli A. Musculoskeletal manifestations of childhood cancer and differential diagnosis with juvenile idiopathic arthritis (ONCOREUM): a multicentre, cross-sectional study. THE LANCET. RHEUMATOLOGY 2021; 3:e507-e516. [PMID: 38279403 DOI: 10.1016/s2665-9913(21)00086-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 10/08/2023]
Abstract
BACKGROUND Presenting symptoms of childhood cancers might mimic those of rheumatic diseases. However, the evidence available to guide differential diagnosis remains scarce. Preventing wrong or delayed diagnosis is therefore important to avoid incorrect administration of glucocorticoid or immunosuppressive therapy and worsening of prognosis. As such, we aimed to assess the prevalence and characteristics of presenting musculoskeletal manifestations in patients at cancer onset and to identify the factors that differentiate childhood malignancies with arthropathy from juvenile idiopathic arthritis. METHODS We did a multicentre, cross-sectional study at 25 paediatric haemato-oncology centres and 22 paediatric rheumatology centres in Italy. We prospectively recruited patients who were younger than 16 years that were newly diagnosed with cancer or juvenile idiopathic arthritis. We excluded patients with glucocorticoid pre-treatment (>1 mg/kg per day of oral prednisone or equivalent for ≥2 consecutive weeks). We collected data for patients with a new diagnosis of cancer or juvenile idiopathic arthritis using an electronic case report form on a web-based platform powered by the Cineca Interuniversity Consortium. The primary outcome was to describe the frequency and characteristics of musculoskeletal manifestations at cancer onset; and the secondary outcome was to identify factors that could discriminate malignancies presenting with arthropathy, with or without other musculoskeletal symptoms, from juvenile idiopathic arthritis using multivariable logistic regression analysis. FINDINGS Between May 1, 2015, and May 31, 2018, 1957 patients were eligible, of which 1277 (65%) had cancer and 680 (35%) had juvenile idiopathic arthritis. Musculoskeletal symptoms occurred in 324 (25% [95% CI 23·0-27·8]) of 1277 patients with cancer, of whom 207 had arthropathy. Patients with malignant bone tumours had the highest frequency of musculoskeletal symptoms (53 [80%] of 66), followed by patients with Langerhans histiocytosis (16 [47%] of 34), leukaemia (189 [32%] of 582), soft-tissue sarcomas (16 [24%] of 68), and neuroblastoma (21 [19%] of 109). In the 324 patients with cancer and musculoskeletal symptoms, the most common complaints were joint pain (199 [61%]), followed by limb bone pain (112 [35%]). Joint involvement had a prevalent monoarticular pattern (100 [48%] of 207) and oligoarticular pattern (86 [42%] had 2-4 joints involved and 20 [10%] had >4 joints involved), with the most frequently involved joints being the hip (88 [43%] of 207) and knee (81 [39%]). On multivariable analysis, limb bone pain was the independent variable most strongly associated with cancer (odds ratio [OR] 87·80 [95% CI 18·89-408·12]), followed by weight loss (59·88 [6·34-565·53]), thrombocytopenia (12·67 [2·40-66·92]), monoarticular involvement (11·30 [4·09-31·19]), hip involvement (3·30 [1·13-9·61]), and male sex (2·40 [1·03-5·58]). Factors independently associated with juvenile idiopathic arthritis were morning stiffness (OR 0·04 [95% CI 0·01-0·20]), joint swelling (0·03 [0·01-0·09]), and involvement of the small hand joints (0·02 [0-1·05]). INTERPRETATION Our study provides detailed information about presenting musculoskeletal manifestations of childhood cancers and highlights the clinical and laboratory features that are most helpful in the differential diagnosis with juvenile idiopathic arthritis. FUNDING Associazione Lorenzo Risolo.
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Affiliation(s)
- Adele Civino
- Unità di Reumatologia e Immunologia Pediatrica, Ospedale Vito Fazzi, Lecce, Italy.
| | - Giovanni Alighieri
- Unità di Pediatra-UTIN, Azienda Ospedaliera Cardinale G Panico, Tricase, Italy
| | - Eleonora Prete
- Dipartimento di Ematologia, Azienda Ospedaliera Cardinale G Panico, Tricase, Italy
| | - Anna Maria Caroleo
- Dipartimento di Oncoematologia Pediatrica, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Luciana Vinti
- Dipartimento di Oncoematologia Pediatrica, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Micol Romano
- Divisione di Reumatologia, ASST G Pini-CTO, Milano, Italy
| | - Nicola Santoro
- Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Giovanni Filocamo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tamara Belotti
- Clinica Pediatrica, Oncologia ed Ematologia Pediatrica Lalla Seràgnoli, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Francesca Santarelli
- Dipartimento di Pediatria, Ospedale Pediatrico Regina Margherita, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Gorio
- Unità di Oncoematologia Pediatrica e TMO, Spedali Civili, Brescia, Italy
| | | | - Antonella Colombini
- Unità di Oncoematologia Pediatrica, Fondazione MBBM/AO San Gerardo Clinica Pediatrica Universitaria, Monza, Italy
| | - Serena Pastore
- Dipartimento di Pediatria, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | - Simone Cesaro
- Oncoematologia Pediatrica, Dipartimento di Assistenza Integrata Materno Infantile, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | - Patrizia Barone
- Dipartimento di Pediatria, Azienda Ospedaliero Universitaria, Policlinico di Catania, Catania, Italy
| | - Federico Verzegnassi
- Unità di Oncoematologia Pediatrica, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Alma Nunzia Olivieri
- Dipartimento della donna, del bambino e di chirurgia generale e specialistica, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Monica Ficara
- Divisione di Oncoematologia Pediatrica, Ospedale Policlinico, Modena, Italy
| | - Angela Miniaci
- Clinica Pediatrica, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Giovanna Russo
- Unità di Oncoematologia Pediatrica, Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Italy
| | - Romina Gallizzi
- Unità di Pediatria, Azienda Ospedaliera Universitaria Gaetano Martino, Messina, Italy
| | | | - Luciana Breda
- Reumatologia Pediatrica, Università di Chieti, Italy
| | - Rossella Mura
- Oncoematologia Pediatrica, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | | | - Daniela Onofrillo
- Unità di Oncoematologia Pediatrica, Dipartimento di Ematologia, Ospedale di Pescara, Italy
| | - Bianca Lattanzi
- Azienda Ospedaliera Universitaria, Ospedale Pediatrico G Salesi, Ancona, Italy
| | - Elisa Tirtei
- SC Oncologia Pediatrica, Ospedale Infantile Regina Margherita, AOU Città della Salute e della scienza, Università di Torino, Italy
| | | | - Raffaela De Santis
- Dipartimento di Pediatria, Unità di Oncoematologia Pediatrica, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Rita Consolini
- Dipartimento di Pediatria, Università di Pisa, Pisa, Italy
| | - Annalisa Arlotta
- Unità di Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria di Parma, Italy
| | - Francesco La Torre
- Reumatologia Pediatrica, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari-Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - Chiara Mainardi
- DIDAS Salute della Donna e del Bambino, Divisione di Oncoematologia Pediatrica e Trapianto di cellule ematopoietiche, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | | | - Elisa Coassin
- SOSD Oncologia del Giovane e Radioterapia Pediatrica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Ilaria Capolsini
- A O U S M Della Misericordia, Oncoematologia Pediatrica con TCSE, Perugia, Italy
| | - Roberta Burnelli
- Unità di Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Sant'Anna di Ferrara, Cona, Italy
| | | | - Francesca Soscia
- Unità di Pediatria, Ospedale Santa Maria della Stella, Orvieto, Italy
| | | | - Donato Rigante
- Dipartimento di Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy; Università Cattolica Sacro Cuore, Roma, Italy
| | | | - Carmela De Fusco
- Dipartimento di Oncologia Pediatrica, AORN Santobono-Pausilipon, Napoli, Italy
| | | | - Andrea Roncadori
- Healthcare Administration, IRCCS-Istituto Romagnolo per lo Studio dei Tumori Dino Amadori-IRST, Meldola, FC, Italy
| | - Elisa Rossi
- Consorzio Interuniversitario Cineca, Casalecchio di Reno, Italy
| | - Giulia Stabile
- Consorzio Interuniversitario Cineca, Casalecchio di Reno, Italy
| | - Andrea Biondi
- Unità di Oncoematologia Pediatrica, Fondazione MBBM/AO San Gerardo Clinica Pediatrica Universitaria, Monza, Italy
| | - Loredana Lepore
- Dipartimento di Pediatria, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy
| | - Valentino Conter
- Unità di Oncoematologia Pediatrica, Fondazione MBBM/AO San Gerardo Clinica Pediatrica Universitaria, Monza, Italy
| | - Roberto Rondelli
- Clinica Pediatrica, Oncologia ed Ematologia Pediatrica Lalla Seràgnoli, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Andrea Pession
- Clinica Pediatrica, Oncologia ed Ematologia Pediatrica Lalla Seràgnoli, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genova, Italy; Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Pediatric Rheumatology, Sechenov First Moscow State Medical University, Moscow, Russian
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Boccuzzi E, Ferro VA, Cinicola B, Schingo PM, Strocchio L, Raucci U. Uncommon Presentation of Childhood Leukemia in Emergency Department: The Usefulness of an Early Multidisciplinary Approach. Pediatr Emerg Care 2021; 37:e412-e416. [PMID: 30461671 DOI: 10.1097/pec.0000000000001694] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ABSTRACT Leukemia is the most common childhood malignancy, and it is often characterized by pallor, fatigue, cytopenia, and organomegaly; sometimes musculoskeletal symptoms, mainly characterized by diffuse bone pain in the lower extremities, are the onset clinical characteristics of the disease. In these cases, the disease may initially be misdiagnosed as reactive arthritis, osteomyelitis, or juvenile idiopathic arthritis delaying appropriate diagnosis and management. Even if leukopenia, thrombocytopenia, and a history of nighttime pain are reported to be the most important predictive factors for a pediatric leukemia, blood examinations can sometimes be subtle or within normal limits, and this represents a further diagnostic difficulty. Radiological findings of leukemic bone involvement are described in patients with musculoskeletal symptoms of acute lymphoblastic leukemia and often appear before hematologic anomalies, but they are not specific for the disease. However, they could be helpful to get the right diagnosis if integrated with other features; thus, it is important knowing them, and it is mandatory for the multidisciplinary comparison to talk about dubious cases even in an emergency setting. We describe 4 patients visited in the emergency department for musculoskeletal complaints and having radiological lesions and a final diagnosis of acute lymphoblastic leukemia, in whom the onset of the manifestations could mimic orthopedic/rheumatologic diseases.
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Affiliation(s)
- Elena Boccuzzi
- From the Emergency Pediatric Department, Bambino Gesù Children's Hospital, IRCCS
| | - Valentina A Ferro
- From the Emergency Pediatric Department, Bambino Gesù Children's Hospital, IRCCS
| | - Bianca Cinicola
- Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome
| | | | - Luisa Strocchio
- Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Umberto Raucci
- From the Emergency Pediatric Department, Bambino Gesù Children's Hospital, IRCCS
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Raj B K A, Singh KA, Shah H. Orthopedic manifestation as the presenting symptom of acute lymphoblastic leukemia. J Orthop 2020; 22:326-330. [PMID: 32675920 PMCID: PMC7340973 DOI: 10.1016/j.jor.2020.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/24/2020] [Accepted: 05/31/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The diagnosis of Acute lymphoblastic leukemia (ALL) is delayed due to vague presentation and normal hematological investigations. OBJECTIVE The objectives were to identify the frequency of ALL cases presented to the orthopedic department and with normal hematological investigations. MATERIAL AND METHODS 250 consecutive ALL cases were retrospectively evaluated to identify cases with musculoskeletal manifestations, and laboratory investigations. RESULTS Twenty-two patients (4- vertebral compression fractures, 12- joint pain, 6- bone pain), presented primarily to the orthopedic department. Six patients had a normal peripheral smear. CONCLUSION The primary physician should maintain a high index of suspicion despite a normal peripheral smear.
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Affiliation(s)
- Amrath Raj B K
- Department of Orthopaedics, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | | | - Hitesh Shah
- Department of Orthopaedics, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Identifying acute lymphoblastic leukemia mimicking juvenile idiopathic arthritis in children. PLoS One 2020; 15:e0237530. [PMID: 32780759 PMCID: PMC7418991 DOI: 10.1371/journal.pone.0237530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Objective Acute lymphoblastic leukemia (ALL) may present with arthritis implying the risk of being misdiagnosed as juvenile idiopathic arthritis (JIA). The aim of this study was to identify predictors for ALL based on clinical and laboratory information. Methods This cross-sectional, retrospective study compared clinical presentation and laboratory results of 26 children with ALL and arthritis versus 485 children with JIA (433 non-systemic, 52 systemic JIA). Using a Bayesian score approach the findings were evaluated by calculating odds ratios (OR) and lnOR as a measure of diagnostic weight. Results Distinction on clinical grounds was difficult, as even a high number of joints involved did not exclude ALL. One or more hematologic cell counts were low (Hb <10 g/dL, platelet count <100 x 109/L, neutrophil count < 1.0 x 109/L) in 92% with ALL, 25% with systemic JIA and 10% with non-systemic JIA. Neutropenia and thrombocytopenia had the highest ORs of 128 (95% CI 43–387) and 129 (95% CI 26–638), each giving a diagnostic weight of 4. The estimated risks of ALL were 0.2% with normal cell counts and 9%, 67% and 100% when one, two or three cell lines were affected. Conclusion A simple count of cell lines with low counts can serve as a basic diagnostic strategy. Children with tri- or bilinear involvement should be referred to a bone marrow, and those with unilinear involvement a thorough screen for further evidence of ALL (organomegaly, ESR, LDH, uric acid, and blood smear).
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17
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Shiari R, Salar N, Parvneh VJ, Rahmani K, Yeganeh MH, Shiari S. Midfoot Arthritis in Children: Is There Any Relation With Malignancy? CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2020; 13:1179544120924643. [PMID: 32550767 PMCID: PMC7281876 DOI: 10.1177/1179544120924643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/15/2022]
Abstract
Background: Musculoskeletal symptoms are a presenting manifestation in a number of
lymphoproliferative disorders including leukemia, especially in children.
Among these primary symptoms, midfoot arthritis seems to be an important
alarm for malignancy in children. The aim of this study is evaluation
association of midfoot arthritis with malignancy in children. Method: In this cross-sectional study, all medical records of patients with arthritis
were identified and reviewed. All clinical and laboratory data were recorded
in the information form and data were analyzed by SPSS 25 software. Results: A total of 557 cases of arthritis were evaluated, of which 18 (3.2%) cases
have primary symptoms of midfoot arthritis. Four of 18 patients (22.2%) had
B-cell precursor acute lymphoblastic leukemia, that midfoot arthritis was
their first manifestation. Also, their laboratory findings confirmed that
platelet, lactic acid dehydrogenesis, and uric acid values were
significantly higher in these children. Based on statistical evaluation,
there was no significant difference between age and sex in these
patients. Conclusion: According to the findings of the present study, it can be concluded that
“midfoot arthritis” may be the first manifestation of leukemia in children
even with a near-normal hematologic values.
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Affiliation(s)
- Reza Shiari
- Reza Shiari, Department of Pediatric
Rheumatology, Mofid Children’s Hospital, Shariati Ave, Hossinieh Ershad,
15468-15514, Tehran, Iran.
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Oh CK, Kang JW, Lee Y, Myung K, Ha M, Kang J, Kwon EJ, Kim Y, Oh SO, Heo HJ, Kim S, Kim YH. Role of kif2c, A Gene Related to ALL Relapse, in Embryonic Hematopoiesis in Zebrafish. Int J Mol Sci 2020; 21:ijms21093127. [PMID: 32354205 PMCID: PMC7246619 DOI: 10.3390/ijms21093127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 12/18/2022] Open
Abstract
Relapse of acute lymphoblastic leukemia (ALL) is dangerous and it worsens the prognosis of patients; however, prognostic markers or therapeutic targets for ALL remain unknown. In the present study, using databases such as TARGET, GSE60926 and GSE28460, we determined that KIF2C and its binding partner, KIF18B are overexpressed in patients with relapsed ALL compared to that in patients diagnosed with ALL for the first time. As 50% of the residues are exactly the same and the signature domain of KIF2C is highly conserved between human and zebrafish, we used zebrafish embryos as a model to investigate the function of kif2c in vivo. We determined that kif2c is necessary for lymphopoiesis in zebrafish embryos. Additionally, we observed that kif2c is not related to differentiation of HSCs; however, it is important for the maintenance of HSCs as it provides survival signals to HSCs. These results imply that the ALL relapse-related gene KIF2C is linked to the survival of HSCs. In conclusion, we suggest that KIF2C can serve as a novel therapeutic target for relapsed ALL.
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Affiliation(s)
- Chang-Kyu Oh
- Center for Genomic Integrity, Institute for Basic Science (IBS), Ulsan 44919, Korea; (C.-K.O.); (Y.L.); (K.M.)
| | - Ji Wan Kang
- Interdisciplinary Program of Genomic Science, Pusan National University, Yangsan 50612, Korea; (J.W.K.); (M.H.); (J.K.); (E.J.K.); (Y.K.)
| | - Yoonsung Lee
- Center for Genomic Integrity, Institute for Basic Science (IBS), Ulsan 44919, Korea; (C.-K.O.); (Y.L.); (K.M.)
| | - Kyungjae Myung
- Center for Genomic Integrity, Institute for Basic Science (IBS), Ulsan 44919, Korea; (C.-K.O.); (Y.L.); (K.M.)
| | - Mihyang Ha
- Interdisciplinary Program of Genomic Science, Pusan National University, Yangsan 50612, Korea; (J.W.K.); (M.H.); (J.K.); (E.J.K.); (Y.K.)
| | - Junho Kang
- Interdisciplinary Program of Genomic Science, Pusan National University, Yangsan 50612, Korea; (J.W.K.); (M.H.); (J.K.); (E.J.K.); (Y.K.)
| | - Eun Jung Kwon
- Interdisciplinary Program of Genomic Science, Pusan National University, Yangsan 50612, Korea; (J.W.K.); (M.H.); (J.K.); (E.J.K.); (Y.K.)
| | - Youngjoo Kim
- Interdisciplinary Program of Genomic Science, Pusan National University, Yangsan 50612, Korea; (J.W.K.); (M.H.); (J.K.); (E.J.K.); (Y.K.)
| | - Sae-Ock Oh
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Korea; (S.-O.O.); (H.J.H.)
| | - Hye Jin Heo
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Korea; (S.-O.O.); (H.J.H.)
| | - Shin Kim
- Department of Immunology, School of Medicine, Keimyung University, Dalseo-gu, Daegu 42601, Korea
- Institute of Medical Science, Keimyung University, Dalseo-gu, Daegu 42601, Korea
- Correspondence: (S.K.); (Y.H.K.); Tel.: +82-53-258-7359 (S.K.); +82-51-510-8091 (Y.H.K.); Fax: +82-53-258-7355 (S.K.); +82-51-510-8049 (Y.H.K.)
| | - Yun Hak Kim
- Department of Anatomy, School of Medicine, Pusan National University, Yangsan 50612, Korea; (S.-O.O.); (H.J.H.)
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan 50612, Korea
- Correspondence: (S.K.); (Y.H.K.); Tel.: +82-53-258-7359 (S.K.); +82-51-510-8091 (Y.H.K.); Fax: +82-53-258-7355 (S.K.); +82-51-510-8049 (Y.H.K.)
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Sesama M, Bhaskar V, Meena M, Narang M, Aggarwal A, Kotru M. Recurrent arthritis: an unusual diagnosis. Trop Doct 2020; 50:248-249. [PMID: 32281521 DOI: 10.1177/0049475520914839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Musculoskeletal complaints may be the initial manifestation of childhood leukaemias. When these symptoms predominate at the onset, a diagnosis of one of several rheumatic diseases may be entertained. Where blood tests are normal, no bone marrow examination would normally be indicated. The use of immune-suppressing medication, such as steroids, may lead to diagnostic delay or misdiagnosis.
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Affiliation(s)
- Meenakshi Sesama
- Senior Resident, Department of Pediatrics, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Vikram Bhaskar
- Assistant Professor, Department of Pediatrics, University College of Medical Sciences &Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Monika Meena
- Junior Resident, Department of Pediatrics, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Manish Narang
- Professor, Department of Pediatrics, University College of Medical Sciences &Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Anju Aggarwal
- Professor, Department of Pediatrics, University College of Medical Sciences &Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Mrinalini Kotru
- Professor, Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
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20
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Hypnosis for pain in pediatric oncology: relevant and effective or an intervention of the past? Pain 2020; 161:901-915. [PMID: 31895265 DOI: 10.1097/j.pain.0000000000001790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Louvigné M, Rakotonjanahary J, Goumy L, Tavenard A, Brasme JF, Rialland F, Baruchel A, Auclerc MF, Despert V, Desgranges M, Jean S, Faye A, Meinzer U, Lorrot M, Job-Deslandre C, Bader-Meunier B, Gandemer V, Pellier I. Persistent osteoarticular pain in children: early clinical and laboratory findings suggestive of acute lymphoblastic leukemia (a multicenter case-control study of 147 patients). Pediatr Rheumatol Online J 2020; 18:1. [PMID: 31898528 PMCID: PMC6941319 DOI: 10.1186/s12969-019-0376-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of this study was to identify early clinical and laboratory features that distinguish acute lymphoblastic leukemia (ALL) from juvenile idiopathic arthritis (JIA) in children presenting with persistent bone or joint pain for at least 1 month. METHODS We performed a multicenter case-control study and reviewed medical records of children who initially presented with bone or joint pain lasting for at least 1 month, all of whom were given a secondary diagnosis of JIA or ALL, in four French University Hospitals. Each patient with ALL was paired by age with two children with JIA. Logistic regression was used to compare clinical and laboratory data from the two groups. RESULTS Forty-nine children with ALL and 98 with JIA were included. The single most important feature distinguishing ALL from JIA was the presence of hepatomegaly, splenomegaly or lymphadenopathy; at least one of these manifestations was present in 37 cases with ALL, but only in 2 controls with JIA, for an odds ratio (OR) of 154 [95%CI: 30-793] (regression coefficient: 5.0). If the presence of these findings is missed or disregarded, multivariate analyses showed that non-articular bone pain and/or general symptoms (asthenia, anorexia or weight loss) (regression coefficient: 4.8, OR 124 [95%CI: 11.4-236]), neutrophils < 2 × 109/L (regression coefficient: 3.9, OR 50 [95%CI: 4.3-58]), and platelets < 300 × 109/L (regression coefficient: 2.6, OR 14 [95%CI: 2.3-83.9]) were associated with the presence of ALL (area under the ROC curve: 0.96 [95%CI: 0.93-0.99]). CONCLUSIONS Based on our findings we propose the following preliminary decision tree to be tested in prospective studies: in children presenting with at least 1 month of osteoarticular pain and no obvious ALL in peripheral smear, perform a bone marrow examination if hepatomegaly, splenomegaly or lymphadenopathy is present. If these manifestations are absent, perform a bone marrow examination if there is fever or elevated inflammatory markers associated with non-articular bone pain, general symptoms (asthenia, anorexia or weight loss), neutrophils < 2 × 109/L or platelets < 300 × 109/L.
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Affiliation(s)
- Mathilde Louvigné
- Unité d'Onco-Hémato-Immunologie pédiatrique, CHU Angers, 4 rue Larrey, 49933, Angers, France.
| | - Josué Rakotonjanahary
- 0000 0004 0472 0283grid.411147.6Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Angers, 4 rue Larrey, 49933 Angers, France
| | - Laurence Goumy
- 0000 0004 0472 0283grid.411147.6Service de Pédiatrie générale, CHU Angers, Angers, France
| | - Aude Tavenard
- 0000 0001 2175 0984grid.411154.4Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Rennes, Rennes, France
| | - Jean-François Brasme
- 0000 0004 0472 0283grid.411147.6Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Angers, 4 rue Larrey, 49933 Angers, France
| | - Fanny Rialland
- 0000 0004 0472 0371grid.277151.7Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Nantes, Nantes, France
| | - André Baruchel
- 0000 0001 2175 4109grid.50550.35Unité d’Hémato-Immunologie pédiatrique, CHU Robert Debré, Hôpitaux de Paris, Paris, France
| | - Marie-Françoise Auclerc
- 0000 0001 2175 4109grid.50550.35Unité d’Hémato-Immunologie pédiatrique, CHU Robert Debré, Hôpitaux de Paris, Paris, France ,Université de Paris, UFR Paris Diderot, Paris, France
| | - Véronique Despert
- 0000 0001 2175 0984grid.411154.4Service de Pédiatrie générale, CHU Rennes, Rennes, France
| | - Marie Desgranges
- 0000 0001 2175 0984grid.411154.4Service de Pédiatrie générale, CHU Rennes, Rennes, France
| | - Sylvie Jean
- 0000 0001 2175 0984grid.411154.4Service de Pédiatrie générale, CHU Rennes, Rennes, France
| | - Albert Faye
- Université de Paris, UFR Paris Diderot, Paris, France ,0000 0001 2175 4109grid.50550.35Service de Pédiatrie générale Maladies Infectieuses et Médecine Interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant RAISE, CHU Robert Debré, Hôpitaux de Paris, Paris, France
| | - Ulrich Meinzer
- 0000 0001 2175 4109grid.50550.35Service de Pédiatrie générale Maladies Infectieuses et Médecine Interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant RAISE, CHU Robert Debré, Hôpitaux de Paris, Paris, France
| | - Mathie Lorrot
- 0000 0001 2175 4109grid.50550.35Service de Pédiatrie générale Maladies Infectieuses et Médecine Interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant RAISE, CHU Robert Debré, Hôpitaux de Paris, Paris, France
| | - Chantal Job-Deslandre
- 0000 0001 2175 4109grid.50550.35Service de Pédiatrie générale Maladies Infectieuses et Médecine Interne, Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l’enfant RAISE, CHU Robert Debré, Hôpitaux de Paris, Paris, France
| | - Brigitte Bader-Meunier
- 0000 0004 0593 9113grid.412134.1Unité d’Immuno-Hématologie et Rhumatologie Pédiatriques, Hôpital Necker-Enfants Malades, Hôpitaux de Paris, Paris, France
| | - Virginie Gandemer
- 0000 0001 2175 0984grid.411154.4Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Rennes, Rennes, France
| | - Isabelle Pellier
- 0000 0004 0472 0283grid.411147.6Unité d’Onco-Hémato-Immunologie pédiatrique, CHU Angers, 4 rue Larrey, 49933 Angers, France
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22
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Tutelman PR, Chambers CT, Urquhart R, Fernandez CV, Heathcote LC, Noel M, Flanders A, Guilcher GMT, Schulte F, Stinson JN, MacLeod J, Stern M. When "a headache is not just a headache": A qualitative examination of parent and child experiences of pain after childhood cancer. Psychooncology 2019; 28:1901-1909. [PMID: 31276614 DOI: 10.1002/pon.5170] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Today, more than 80% of children diagnosed with cancer are expected to survive. Despite the high prevalence of pain associated with the diagnosis and treatment of childhood cancer, there is a limited understanding of how having cancer shapes children's experience and meaning of pain after treatment has ended. This study addresses this gap by exploring childhood cancer survivors' (CCS') experiences of pain from their perspective and the perspective of their parents. METHODS Twenty semi-structured interviews were completed with CCS (50% female; mean age = 13.20 y, range = 8-17 y) and their parents (90% mothers). Data were analyzed using interpretive phenomenological analysis. RESULTS Analyses revealed three superordinate themes present in the data: (a) pain is a changed experience after childhood cancer; (b) new or ambiguous pains may be interpreted by CCS and parents as a threat of disease recurrence, late effects, or a secondary cancer; and (c) pain interpretation occurs within the broader context of how CCS and parents appraise their cancer experience. Parents generally appraised their child's cancer and pain as more threatening and were influential in guiding their child's interpretations. CONCLUSIONS The cancer experience played an important role in shaping CCS' and their parents' experience and interpretation of pain in survivorship. This study provides novel data to inform the development and refinement of new and existing conceptual models of pain and symptom perception after cancer. The results also point to key areas for future investigation and clinical intervention to address the issue of pain in cancer survivorship.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada.,Departments of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Conrad V Fernandez
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, California, USA
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Annette Flanders
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Gregory M T Guilcher
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada.,Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Fiona Schulte
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Maya Stern
- Patient Partner, Toronto, Ontario, Canada
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23
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Angsubhakorn N, Suvannasankha A. Acute lymphoblastic leukaemia with osteolytic bone lesions: diagnostic dilemma. BMJ Case Rep 2018; 2018:bcr-2018-225008. [PMID: 30100571 DOI: 10.1136/bcr-2018-225008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A previously healthy 37-year-old man presented with a 10-month history of intractable back pain. On examination, there was tenderness to palpation along lower thoracic and lumbar spine. Complete blood count showed mild anaemia but was otherwise unremarkable. Imaging studies revealed compression deformities with multiple osteolytic lesions involving multiple levels of the thoracic and lumbar spine. Bone marrow aspiration and biopsy were performed and demonstrated blast cells involving 80% of the bone marrow cellularity. Findings on flow cytometry were consistent with B-lymphoblastic leukaemia. He was subsequently started on hyper-CVAD (fractionated cyclophosphamide, vincristine, Adriamycin and dexamethasone) induction chemotherapy.
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Affiliation(s)
- Natthapon Angsubhakorn
- Department of Medicine, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
| | - Attaya Suvannasankha
- Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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24
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Tripathi N, Shankar RK, Baghdassarian A. Nutritional Rickets Presenting as Chronic Episodic Extremity Pain in a 9-year-old with Autism. Clin Pract Cases Emerg Med 2018; 2:251-254. [PMID: 30083645 PMCID: PMC6075487 DOI: 10.5811/cpcem.2018.2.37206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 12/19/2022] Open
Abstract
Rickets due to vitamin D deficiency, typically presenting as bowed legs in toddlers, is uncommon in the modern era. We describe the case of a nine-year-old girl with autism and developmental delay who was evaluated for chronic intermittent extremity pain for more than one year prior to referral to the emergency department for hypocalcemia and increased alkaline phosphatase, which eventually led to the diagnosis of rickets confirmed by radiographic and laboratory findings. This report highlights the importance of the patient's history of developmental delay and autism in the evaluation and approach to limb pain, and discusses the appropriate diagnostic approach.
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Affiliation(s)
- Noopur Tripathi
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Roopa Kanakatti Shankar
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Children’s Hospital of Richmond at VCU, Department of Pediatrics, Division of Pediatric Endocrinology, Richmond, Virginia
| | - Aline Baghdassarian
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Richmond, Virginia
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25
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Schlappi C, Kulkarni V, Palabindela P, Bemrich-Stolz C, Howard T, Hilliard L, Lebensburger J. Outcomes in Mild to Moderate Isolated Thrombocytopenia. Pediatrics 2018; 142:peds.2017-3804. [PMID: 29891565 PMCID: PMC6317551 DOI: 10.1542/peds.2017-3804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Incidental isolated mild to moderate thrombocytopenia is a frequent laboratory finding prompting a referral to pediatric hematology-oncology. We tested the hypothesis that patients with isolated asymptomatic mild thrombocytopenia would not progress to require an intervention from a pediatric hematologist-oncologist. METHODS This is a 5-year retrospective review of 113 patients referred to pediatric hematology-oncology for isolated thrombocytopenia. Initial, lowest, and current platelet counts along with clinical course and need for interventions were recorded. Thrombocytopenia was categorized as mild (platelet count: 101-140 × 103/μL), moderate (platelet count: 51-100 × 103/μL), severe (platelet count: 21-50 × 103/μL), and very severe (platelet count: ≤20 × 103/μL). RESULTS Eight of 48 patients (17%) referred for initial mild isolated thrombocytopenia progressed to moderate thrombocytopenia at 1 visit. At present, 2 of these patients have moderate thrombocytopenia, 17 remain with mild thrombocytopenia, and 29 patients have resolved thrombocytopenia. Nine of 65 patients (14%) referred for moderate thrombocytopenia progressed to severe or very severe thrombocytopenia on 1 occasion. At present, no patients have severe thrombocytopenia, 18 remain with moderate thrombocytopenia, 14 improved to mild thrombocytopenia, and 33 have resolved thrombocytopenia. Only 3 patients required interventions from a hematologist, whereas 10 patients required therapy from other subspecialties. CONCLUSIONS We only identified 3 patients (3%) with mild to moderate thrombocytopenia who required an intervention from a hematologist to improve platelet counts. Patients with isolated mild thrombocytopenia with a normal bleeding history and physical examination findings frequently have normalized their platelet counts within 1 month.
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Affiliation(s)
| | | | | | | | | | | | - Jeffrey Lebensburger
- Division of Pediatric Hematology Oncology. University of Alabama at Birmingham, Birmingham, Alabama
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26
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Duarte D, Hawkins ED, Lo Celso C. The interplay of leukemia cells and the bone marrow microenvironment. Blood 2018; 131:1507-1511. [PMID: 29487069 DOI: 10.1182/blood-2017-12-784132] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/09/2018] [Indexed: 12/29/2022] Open
Abstract
The interplay of cancer cells and surrounding stroma is critical in disease progression. This is particularly evident in hematological malignancies that infiltrate the bone marrow and peripheral lymphoid organs. Despite clear evidence for the existence of these interactions, the precise repercussions on the growth of leukemic cells are poorly understood. Recent development of novel imaging technology and preclinical disease models has advanced our comprehension of leukemia-microenvironment crosstalk and has potential implications for development of novel treatment options.
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Affiliation(s)
- Delfim Duarte
- Department of Life Sciences, Imperial College London, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
| | - Edwin D Hawkins
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; and
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Cristina Lo Celso
- Department of Life Sciences, Imperial College London, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
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27
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Characteristics of children with acute lymphoblastic leukemia presenting with arthropathy. Clin Rheumatol 2018; 37:2455-2463. [DOI: 10.1007/s10067-018-4034-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
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28
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Zaporowska-Stachowiak I, Łuczak J, Hoffmann K, Stachowiak K, Bryl W, Sopata M. Managing metastatic bone pain: New perspectives, different solutions. Biomed Pharmacother 2017; 93:1277-1284. [DOI: 10.1016/j.biopha.2017.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/28/2017] [Accepted: 07/05/2017] [Indexed: 12/16/2022] Open
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29
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Tsujioka T, Sugiyama M, Ueki M, Tozawa Y, Takezaki S, Ohshima J, Cho Y, Yamada M, Iguchi A, Kobayashi I, Ariga T. Difficulty in the diagnosis of bone and joint pain associated with pediatric acute leukemia; comparison with juvenile idiopathic arthritis. Mod Rheumatol 2017; 28:108-113. [PMID: 28612674 DOI: 10.1080/14397595.2017.1332474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Acute leukemia often causes osteoarthralgia. The aim of this study is characterization of leukemia-associated osteoarthralgia in comparison with juvenile idiopathic arthritis (JIA). METHODS We retrospectively reviewed clinical records of 31 patients with acute leukemia and 13 patients with articular JIA diagnosed between January 2008 and March 2013. Clinical and laboratory findings at the initial examination were compared among the three groups; 10 leukemia with and 21 leukemia without osteoarthralgia and 13 JIA groups. RESULTS Eleven of the 31 leukemic patients (35%) had osteoarthralgia before the diagnosis of leukemia. Peripheral leukemic cells were initially absent in 10 of the 31 leukemia patients including three with osteoarthralgia. Platelet counts over 300 × 109/L were common in JIA, but not in osteoarthralgia group. Mean serum lactate dehydrogenase levels were higher in both of the leukemia groups than JIA group but often within normal or near-normal levels in the leukemia groups. Magnetic resonance imaging was examined in three leukemic patients and demonstrated osteomyelitis-like bone marrow edema in two and periarticular infiltration similar to synovitis in one patient. Three leukemic patients with osteoarthralgia showed partial and transient responses to antibiotic therapy. CONCLUSIONS Leukemia-associated osteoarthralgia is often indistinguishable from rheumatic diseases by imaging and laboratory findings and should be confirmed by bone marrow examination.
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Affiliation(s)
- Takao Tsujioka
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Minako Sugiyama
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Masahiro Ueki
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yusuke Tozawa
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Shunichiro Takezaki
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Junjiro Ohshima
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yuko Cho
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Masafumi Yamada
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Akihiro Iguchi
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Ichiro Kobayashi
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan.,b Center for Pediatric Allergy and Rheumatology , KKR Sapporo Medical Center , Sapporo , Japan
| | - Tadashi Ariga
- a Department of Pediatrics , Hokkaido University Graduate School of Medicine , Sapporo , Japan
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30
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Interleukin-1β as emerging therapeutic target in hematological malignancies and potentially in their complications. Blood Rev 2017; 31:306-317. [PMID: 28495184 DOI: 10.1016/j.blre.2017.05.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/02/2017] [Indexed: 12/12/2022]
Abstract
Interleukin-1β (IL-1β) is a pleiotropic cytokine that exerts multiple roles in both physiological and pathological conditions. It is produced by different cell subsets, and drives a wide range of inflammatory responses in numerous target cells. Enhanced IL-1β signaling is a common event in patients of hematological malignancies. Recent body of evidence obtained in preclinical models shows the pathogenic role of these alterations, and the promising therapeutic value of IL-1 targeting. In this review, we further highlight a potential contribution of IL-1β linking to complications and autoimmune disease that should be investigated in future studies. Hence, drugs that target IL-1 may be helpful to improve outcome or reduce morbidity in patients. Some of them are FDA-approved, and used efficiently against autoimmune diseases, like IL-1 receptor antagonist. In the clinic, however, this agent seems to have limited properties. Current improved drugs will allow to determine the true potential of IL-1 and IL-1β targeting as therapy in hematological malignancies and their related complications.
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31
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Puri V, Sharma P, Gopalakrishnan S, Sikka M, Avasthi R. Hypercalcemia, multiple osteolytic lesions, and acute renal failure: a rare presentation of B-cell acute lymphoblastic leukemia. Blood Res 2017; 52:65-67. [PMID: 28401105 PMCID: PMC5383591 DOI: 10.5045/br.2017.52.1.65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/05/2016] [Accepted: 08/29/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Vandana Puri
- Department of Pathology, University College of Medical Sciences & GTB Hospital, Delhi, India
| | - Pooja Sharma
- Department of Pathology, University College of Medical Sciences & GTB Hospital, Delhi, India
| | | | - Meera Sikka
- Department of Pathology, University College of Medical Sciences & GTB Hospital, Delhi, India
| | - Rajnish Avasthi
- Department of Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India
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32
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Kang S, Im HJ, Bae K, Park SS. Influence of Musculoskeletal Manifestations as the Only Presenting Symptom in B-Cell Acute Lymphoblastic Leukemia. J Pediatr 2017; 182:290-295.e1. [PMID: 28063690 DOI: 10.1016/j.jpeds.2016.11.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 10/14/2016] [Accepted: 11/28/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the clinical and prognostic impact of musculoskeletal manifestations as the only initial presenting symptom in childhood acute lymphoblastic leukemia (ALL). STUDY DESIGN We retrospectively reviewed 158 children with precursor B-cell type ALL who were followed up for >2 years. The patients were assigned to the groups musculoskeletal manifestations (n = 24) or nonmusculoskeletal manifestations (n = 134) based on initial presenting symptom. The symptom duration (regarding any initial presenting symptom) and the leukemic symptom duration (regarding symptoms of systemic manifestation, such as fever, bleeding, or pallor) were assessed, along with other clinical characteristics. RESULTS The musculoskeletal manifestations group exhibited a longer symptom duration than the nonmusculoskeletal manifestations group (43 days vs 22 days, P = .006), but overall survival did not significantly differ between the groups. Multivariate analysis indicated that a longer symptom duration did not affect prognosis but that a longer leukemic symptom duration was associated with a poorer prognosis (hazard ratio, 7.720; P = .048). CONCLUSION Musculoskeletal manifestations are associated significantly with diagnostic delay, but this delay does not affect the prognosis. Diagnostic delay after the onset of leukemic symptoms, however, does appear to affect the prognosis. Intensive evaluations for hematologic malignancies may be unnecessary in children who complain of limb pain without any definite cause, unless they also present with accompanying leukemic symptoms.
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Affiliation(s)
- Seungcheol Kang
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Joon Im
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kunhyung Bae
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Sung Park
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Kishore M, Kumar V, Marwah S, Nigam AS. Unusual Presentation of Acute Leukaemia: A Tripod of Cases. J Clin Diagn Res 2016; 10:ED04-ED08. [PMID: 27891349 DOI: 10.7860/jcdr/2016/21472.8715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022]
Abstract
Acute Leukemia is one of the common haematological malignancies encountered with varied clinical and haematological presentation. In acute leukaemia, complications like bleeding and infection cause significant morbidity and mortality, thus overshadowing the thromboembolic events. Among the various malignant haematological disorders, the association of thromboembolic events is often noted with acute promyelocytic leukemia, though the overall frequency of such events remains very low. Acute Lymphoblastic Leukemia (ALL) is, however, more common than Acute non-lymphoblastic Leukaemia. Usually patients present with symptoms because of cytopenias, organomegaly, lymphadenopathy and bone pain, including other skeletal abnormalities. Granular Acute lymphoblastic Leukaemia (G-ALL) may be misdiagnosed as Acute Myeloid Leukemia (AML) because of the presence of cytoplasmic granules in the lymphoblasts. This variant of ALL is usually noted in children, but may be seen in adults too. It is also important to note that asymptomatic skeletal involvement can be seen in 40-60% of patients with ALL, but pathological fractures and osteolytic lesions along with hypercalcemia at the time of presentation are very rare. Herein, we present a series of three cases of acute Leukemia presenting with unusual clinical and other rare haematological findings.
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Affiliation(s)
- Manjari Kishore
- Senior Resident, Department of Pathology, PGIMER, Dr. RML Hospital , New Delhi, India
| | - Vijay Kumar
- Associate Professor, Department of Pathology, PGIMER, Dr. RML Hospital , New Delhi, India
| | - Sadhna Marwah
- Professor, Department of Pathology, PGIMER, Dr. RML Hospital , New Delhi, India
| | - Abhay S Nigam
- Consultant Pathologist, Department of Pathology, PGIMER, Dr. RML Hospital , New Delhi, India
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The Usefulness of T1-Weighted Magnetic Resonance Images for Diagnosis of Acute Leukemia Manifesting Musculoskeletal Symptoms prior to Appearance of Peripheral Blood Abnormalities. Case Rep Pediatr 2016; 2016:2802596. [PMID: 27830102 PMCID: PMC5088267 DOI: 10.1155/2016/2802596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/28/2016] [Indexed: 11/17/2022] Open
Abstract
The patients with acute leukemia occasionally present with musculoskeletal symptoms initially, including bone pain, joint pain, muscular pain, and functional impairment. Without abnormal findings of peripheral blood cell counts or smear, the correct diagnosis tends to be delayed. Magnetic resonance imaging is often performed to examine musculoskeletal abnormalities; it can simultaneously reveal the bone marrow composition with high anatomical resolution and excellent soft tissue contrast. We present 4 pediatric patients who were initially diagnosed with acute pyogenic osteomyelitis or arthritis, based on the elevated white blood cell counts and/or C-reactive protein in addition to the localized high signal intensity on T2-weighted magnetic resonance images. Finally, they were diagnosed with B-cell precursor acute lymphoblastic leukemia by bone marrow examination. The period between the onset of musculoskeletal symptoms and the diagnosis of leukemia ranged from 20 days to 6 months. In all cases, the T1-weighted magnetic resonance images taken prior to detection of peripheral blood abnormality revealed diffuse low signal intensity of the bone marrow in regions adjacent or contralateral to localized musculoskeletal symptoms. These findings should raise the suspicion of leukemia even without abnormalities in peripheral blood.
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Bilateral Irritable Hip: A Rare Presentation of Leukemia in Children. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2016. [DOI: 10.5812/pedinfect.28388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chien YL, Huang FL, Huang CM, Chen PY. Clinical approach to fever of unknown origin in children. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 50:893-898. [PMID: 27143687 DOI: 10.1016/j.jmii.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/07/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Fever of unknown origin (FUO) can be caused by many clinical conditions and remains a diagnostic challenge in clinical practice. The etiology of FUO varies markedly among different age groups, geographic areas, and seasons. A four-stage investigative protocol for FUO is widely applied in clinical practice. The aim of this study was to evaluate the usefulness of this four-stage protocol for identifying the etiology of FUO in children. METHODS We enrolled children younger than 18 years of age who were admitted to the Taichung Veterans General Hospital during the period from January 2006 to December 2014 with FUO persisting for more than 3 weeks. The four-stage FUO investigative guideline was used to evaluate the etiology of fever in all patients enrolled in the study. RESULTS The etiology of FUO was identified in 79 (84.9%) of the 93 patients enrolled in the study. The most common cause of FUO was infectious disease (37.6%), followed by malignancy (17.2%), miscellaneous disease (16.1%), and collagen vascular disease (14.0%). With respect to the four-stage survey of FUO, 36 of the 79 patients (45.6%) were identified in Stage 3, 28 patients (35.4%) in Stage 2, 13 patients (16.5%) in Stage 4, and only two patients (2.5%) in Stage 1. CONCLUSION A well-designed systemic review of the epidemiological information, medical history, physical examination, laboratory analysis, and adequate invasive procedures provide adequate data to identify the most common causes of FUO in children.
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Affiliation(s)
- Ya-Li Chien
- Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Pediatrics, Lin Shin Medical Corporation Lin Shin Hospital, Taichung, Taiwan
| | - Fang-Liang Huang
- Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Ming Huang
- Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Yen Chen
- Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
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Abstract
BACKGROUND At disease onset, children with acute lymphoblastic leukaemia (ALL) may present with arthralgia or even signs of arthritis. This might cause misdiagnosis and thereby lead to prolonged diagnostic delay. The present study aimed to identify children with ALL with joint involvement and to compare their characteristics and outcome with children with ALL without joint involvement. METHODS Case records of 286 children diagnosed with ALL between 1992 and 2013 were reviewed and analysed in this retrospective, descriptive study. RESULTS Fifty-three (18.5%) children with ALL presented with localised joint pain, and half of them had objective signs of arthritis. The mean number of joints involved was 2.5, most frequently presenting as asymmetric oligoarthritis. The suspected misdiagnosis were reactive arthritis (19/53), osteomyelitis (9/53) and juvenile idiopathic arthritis (8/53). Children with joint involvement had less objective signs of haematological disease. Cytopenia was absent in 24% in children with joint involvement (vs 8% without, p=0.001), 50% had only one cell line affected (vs 21%, p=0.0005) and 44% had no organomegaly (vs 29%, p=0.05). Median diagnostic delay was 4 vs 2 weeks. The 5-year event-free and overall survival was superior for children with joint involvement: 94% vs 87% (p=0.049), and 96% vs 83% (p=0.044). CONCLUSIONS ALL with joint involvement is a frequent finding (18.5%). The clinical signs of leukaemia are less prominent, but non-articular pain should alert the clinician of a possible diagnosis of leukaemia. The overall and event-free survivals were superior compared with the children without joint involvement.
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Affiliation(s)
- Ninna Brix
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Steen Rosthøj
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
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Nguyen TV, Melville A, Nath S, Story C, Howell S, Sutton R, Zannettino A, Revesz T. Bone Marrow Recovery by Morphometry during Induction Chemotherapy for Acute Lymphoblastic Leukemia in Children. PLoS One 2015; 10:e0126233. [PMID: 25962143 PMCID: PMC4427405 DOI: 10.1371/journal.pone.0126233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 03/30/2015] [Indexed: 02/05/2023] Open
Abstract
Bone marrow architecture is grossly distorted at the diagnosis of ALL and details of the morphological changes that accompany response to Induction chemotherapy have not been reported before. While marrow aspirates are widely used to assess initial response to ALL therapy and provide some indications, we have enumerated marrow components using morphometric analysis of trephine samples with the aim of achieving a greater understanding of changes in bone marrow niches. Morphometric analyses were carried out in the bone marrow trephine samples of 44 children with ALL, using a NanoZoomer HT digital scanner. Diagnostic samples were compared to those of 32 control patients with solid tumors but without marrow involvement. Samples from patients with ALL had significantly increased fibrosis and the area occupied by bony trabeculae was lower than in controls. Cellularity was higher in ALL samples due to leukemic infiltration while the percentage of normal elements such as megakaryocytes, adipocytes, osteoblasts and osteoclasts were all significantly lower. During the course of Induction therapy, there was a decrease in the cellularity of ALL samples at day 15 of therapy with a further decrease at the end of Induction and an increase in the area occupied by adipocytes and the width of sinusoids. Reticulin fibrosis decreased throughout Induction. Megakaryocytes increased, osteoblasts and osteoclasts remained unchanged. No correlation was found between clinical presentation, early response to treatment and morphological changes. Our results provide a morphological background to further studies of bone marrow stroma in ALL.
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Affiliation(s)
- Tuong-Vi Nguyen
- Erasmus University, Rotterdam, The Netherlands; SA Pathology at Women's and Children's Hospital, Adelaide, Australia
| | - Anna Melville
- Women's and Children's Research Institute, Adelaide, Australia
| | | | - Colin Story
- SA Pathology at Women's and Children's Hospital, Adelaide, Australia
| | - Stuart Howell
- Data Management & Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide, Australia
| | - Rosemary Sutton
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW, Randwick, NSW, Australia
| | - Andrew Zannettino
- Faculty of Health Science, University of Adelaide, Adelaide, Australia; Centre for Cancer Biology, SA Pathology, Adelaide, Australia
| | - Tamas Revesz
- SA Pathology at Women's and Children's Hospital, Adelaide, Australia; Faculty of Health Science, University of Adelaide, Adelaide, Australia
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Sakata H, Nakao A, Matsuda K, Yoshie N, Yamada T, Osako T, Iwano M, Kotani J. Acute leukemia presenting as bone pain with normal white blood cell count. Acute Med Surg 2014; 1:249. [PMID: 29930859 DOI: 10.1002/ams2.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Hiroyuki Sakata
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan
| | - Atsunori Nakao
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan
| | - Kennichi Matsuda
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan
| | - Norichika Yoshie
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan
| | - Taihei Yamada
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan
| | - Takaaki Osako
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan
| | - Mika Iwano
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan
| | - Joji Kotani
- Department of Emergency, Disaster and Critical Care Medicine Hyogo College of Medicine Hyogo Japan
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Kisacik B, Onat AM, Kasifoglu T, Pehlivan Y, Pamuk ON, Dalkilic E, Donmez S, Bilge SY, Yilmaz S, Erdem H, Mercan R, Ozturk MA, Bes C, Soy M, Erten S, Cobankara V, Senel S, Oner FA, Direskeneli H, Yilmaz S, Yazici A, Emmungil H, Aksu K, Kul S, Cetin GY, Sayarlioglu M. Diagnostic dilemma of paraneoplastic arthritis: case series. Int J Rheum Dis 2014; 17:640-5. [PMID: 24433553 DOI: 10.1111/1756-185x.12277] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Paraneoplastic arthritis (PA) may mimic rheumatic diseases. While presenting the demographic and laboratory features of the patients diagnosed with PA, this study also aims to provide possible appropriate tools to differentiate the PA cases from early rheumatoid arthritis (ERA). METHODS Sixty-five patients with PA (male/female: 43/22) from 15 different rheumatology clinics and 50 consecutive patients with ERA (male/female: 13/37) fulfilling the 2010 American College of Rheumatology (ACR) criteria for the diagnosis if the RA from Gaziantep Rheumatology Early Arthritis Trial (GREAT) as controls who were diagnosed at least 12 months before, were enrolled into study. RESULTS Mean ages of the patients with PA and ERA were 50.2 ± 15.3, and 42.7 ± 12.3, respectively, and the mean ages of the patients with PA were significantly higher than the ERA. Unlike the ERA patients, in our case series PA was predominantly observed among males. Oligoarthritis was significantly higher in solid tumors in contrast to ERA (P = 0.001). Polyarthritis and symmetric arthritis were significantly higher in the ERA group in contrast to all malignancies (P = 0.001). Rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (anti-CCP) positivity were significantly higher in the ERA group (each P = 0.001). Lactic dehydrogenase levels of hematologic malignancies were significantly higher than other groups (each, P = 0.001). CONCLUSIONS ERA patients had more symmetric joint involvement than PA; laboratory markers could be also an alternative where there is high RF and anti-CCP positivity with antibody levels among the ERA patients. Finally, the demographic features can be used as differentiating factors; ERA was seen predominantly among females aged 40-59 years which refers to young adults.
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Affiliation(s)
- Bunyamin Kisacik
- Department of Internal Medicine, Division of Rheumatology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
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Zombori L, Kovacs G, Csoka M, Derfalvi B. Rheumatic symptoms in childhood leukaemia and lymphoma-a ten-year retrospective study. Pediatr Rheumatol Online J 2013; 11:20. [PMID: 23641776 PMCID: PMC3645950 DOI: 10.1186/1546-0096-11-20] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 04/26/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The initial symptoms of childhood leukaemia and lymphoma are often similar to those of juvenile idiopathic arthritis (JIA). In our study, we analyzed the frequency and characteristics of musculoskeletal complaints as the initial presenting symptoms of newly diagnosed leukaemia and lymphoma patients in the past 10 years in our clinic. METHODS Using the Hungarian Tumour Register, we performed a retrospective analysis of the medical records of 166 new leukaemia and 95 new lymphoma pediatric patients treated from 1999 to 2009 at the 2nd. Dept. of Paediatrics of the Semmelweis University in Budapest. RESULTS Twenty percent of the leukaemic (33 children) and 2% of the lymphoma patients (2 children) had musculoskeletal symptoms at first presentation. Two-thirds of both groups of patients had other general symptoms like fever and/or fatigue. The hip was the most frequently affected joint (7/33) in the leukaemic patients. Twenty-four percent of all the children had been previously evaluated by an orthopaedist; 12% had visited another rheumatologist prior to diagnosis. Imaging had been done in an unexpectedly low number of patients prior to referral to our unit (radiographs: 16 or 48%, ultrasound: 5 patients or 15%). Radiographs of the affected joints were abnormal in only one case (1/16, 6%). The joint ultrasound was abnormal in only three children of 5 studied (3/5, 60%). Anaemia (26/32, 6%), thrombocytopenia (78%) and LDH elevation (3-4 times the normal count) were frequent in the leukaemic patients. Half of the cases had a normal leukocyte count. The lymphoma group had similar results. Two patients of the leukaemia group received steroid treatment before the final diagnosis. Severe pain out of proportion to physical findings is another clue. CONCLUSIONS Haematologic malignancies must be excluded before initiation of therapy for childhood arthritis among children presenting with musculoskeletal signs and symptoms, particularly in atypical cases. Malignancies are to be suspected when pain is disproportionately severe compared to the physical examination findings, and when anaemia, thrombocytopenia, and an elevated LDH level are present. Diagnosing leukaemia early is important because the use of steroids and immunosuppressive medications may mask and delay its diagnosis. Additionally, pre-treatment of presumed JIA patients with these drugs who eventually are diagnosed to have a malignancy may lead to the malignancy being steroid-resistant and more difficult to treat.
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Affiliation(s)
- Luca Zombori
- 2nd Department of Paediatrics, Semmelweis University Budapest, 1094, Tuzolto u 7-9, Budapest, Hungary
| | - Gabor Kovacs
- 2nd Department of Paediatrics, Semmelweis University Budapest, 1094, Tuzolto u 7-9, Budapest, Hungary
| | - Monika Csoka
- 2nd Department of Paediatrics, Semmelweis University Budapest, 1094, Tuzolto u 7-9, Budapest, Hungary
| | - Beata Derfalvi
- 2nd Department of Paediatrics, Semmelweis University Budapest, 1094, Tuzolto u 7-9, Budapest, Hungary
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“I Don't Want To Brush My Teeth!” The Case of an 8-Year-Old With Gingival Bleeding. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2013. [DOI: 10.1016/j.cpem.2013.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Agodi A, Barchitta M, Trigilia C, Barone P, Marino S, Garozzo R, La Rosa M, Russo G, Di Cataldo A. Neutrophil counts distinguish between malignancy and arthritis in children with musculoskeletal pain: a case-control study. BMC Pediatr 2013; 13:15. [PMID: 23368751 PMCID: PMC3563449 DOI: 10.1186/1471-2431-13-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify the predictive factors for malignancies using basic clinical and laboratory information in children presenting with musculoskeletal pain and eventually diagnosed with juvenile idiopathic arthritis (JIA) or malignancy. METHODS A retrospective case-control chart review research examining laboratory data from patients referred for musculoskeletal pain in 2001-2010 and diagnosed with malignancy or JIA was performed. The validity of each test for the diagnosis of neoplasia was assessed by calculating the sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and likelihood ratios. RESULTS A total of 134 patients were enrolled. Statistically significant differences were found in neutrophil count, Hb, LDH, IgA and C4 values, ANA, anti-EA EBV IgG and anti-CMV IgG titres. High LDH value and anti-CMV IgG were the most predictive factors for neoplasia. High specificity factors for neoplasia were abnormal values of neutrophil count, Hb, IgA and C4, and the presence of anti-EA EBV and anti-CMV IgG. High PPV were recorded for abnormal neutrophil count, Hb value and anti-CMV titre. A low NPV was found only for anti-EA EBV and anti-CMV titres. CONCLUSIONS In this setting of patients, minimum changes in neutrophil count, particularly if associated with low Hb and high LDH levels, are to be thoroughly considered, because they appear as the most predictive factors for the diagnosis of tumour.
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Affiliation(s)
- Antonella Agodi
- Department GF Ingrassia, University of Catania, Via Santa Sofia 87, Catania 95123, Italy
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Brasme JF, Morfouace M, Grill J, Martinot A, Amalberti R, Bons-Letouzey C, Chalumeau M. Delays in diagnosis of paediatric cancers: a systematic review and comparison with expert testimony in lawsuits. Lancet Oncol 2012; 13:e445-59. [PMID: 23026830 DOI: 10.1016/s1470-2045(12)70361-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Delayed diagnosis of paediatric cancers is reported regularly and is a source of remorse for physicians and parents and a leading cause of malpractice claims. We did a systematic review of information about the distribution, determinants, and consequences of time to diagnosis of paediatric malignancies and compared these findings with those of court-appointed expert witnesses in malpractice claims in Canada and France. Time to diagnosis varied widely between tumour types in the 98 relevant studies (medians ranged from 2-260 weeks) without any significant decrease with time. Determinants of a long delay in diagnosis included older age, qualification of the first physician contacted, non-specific symptoms, histological type, and tumour localisation. Delayed diagnosis was associated with poor outcome for retinoblastoma and possibly for leukaemia, nephroblastoma, and rhabdomyosarcoma (data were insufficient for definitive conclusions). It was not associated with an adverse outcome for most CNS tumours, osteosarcoma or Ewing's sarcoma, and, paradoxically, was frequently associated with better outcomes than was short time to diagnosis in these cancers. A third of the court-appointed experts provided testimony concordant with the medical literature. The relations between delay in diagnosis and outcome are complex and probably depend more on tumour biology than on parental or medical factors.
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Affiliation(s)
- Jean-François Brasme
- INSERM U953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Hôpital Saint-Vincent-de-Paul, Paris, France.
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Niscola P, Tendas A, Scaramucci L, Giovannini M, De Sanctis V. Pain in blood cancers. Indian J Palliat Care 2012; 17:175-83. [PMID: 22346041 PMCID: PMC3276813 DOI: 10.4103/0973-1075.92333] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patients with blood-related cancers (BRC) suffer from a substantial symptom burden, including several pain syndromes sustained by different causes and pathogenetic mechanisms. So, with regard to pain, a multifaceted clinical scenario may be observed in this setting. Indeed, pain may be correlated to disease itself, to disease-associated complications, to iatrogenic causes or may be due to unrelated clinical conditions. A close diagnostic procedure for the assessment of the underlying causes of the pain and of its pathogenetic mechanisms may direct the treatment approach which should be based on a multidisciplinary management and requires the integration of etiology-targeted interventions and painkilling drugs. The World Health Organization's three-step analgesic ladder for cancer pain relief can provide adequate pain control using oral drugs in most patients with BRC on pain, although more complex interventions may be necessary for many difficult-to-treat pain syndromes which are not infrequently encountered in this setting.
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Sharma SK, Seth T, Mishra P, Mahapatra M. Bone Infarcts in a Case of Chronic Myeloid Leukemia: Chronic Phase. Indian J Hematol Blood Transfus 2012; 28:187-8. [DOI: 10.1007/s12288-011-0122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 09/28/2011] [Indexed: 10/16/2022] Open
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Teo WY, Chan MY, Ng KC, Tan AM. Bony presentations of childhood haematological malignancy to the emergency room. J Paediatr Child Health 2012; 48:311-6. [PMID: 22077629 DOI: 10.1111/j.1440-1754.2011.02230.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Bony complaints are well-recognised symptoms of childhood haematological malignancy. However, this elusive symptom complex of haematological malignancy is not easily recognised in the emergency room (ER) where musculoskeletal problems are frequent. This study reviews bony complaints of childhood haematological malignancy in the ER. METHODS This was a retrospective study of 148 children diagnosed with haematological malignancy between March 2002 and February 2007. RESULTS Twenty-one cases (14.2%) presented with bony complaints to the ER within 3 months prior diagnosis of malignancy. The median age was 5.1 years, and majority (90.5%) had acute lymphoblastic leukaemia. Fifteen cases were undiagnosed for malignancy at first visit; diagnoses included pulled elbow, lower limb sprain and septic arthritis, with 21 days median time to correct diagnosis. In this undiagnosed group, history of trauma, fever, multiple bony site involvement, normal radiography and blood counts were common. Undiagnosed cases were referred to orthopaedics, paediatrics, rheumatology or the general practitioner, hospitalised or discharged without follow-up. CONCLUSION The diagnosis of childhood haematological malignancy with first bony presentation to the ER was challenging, with a high prevalence of 71.4% undiagnosed cases at first visit. We highlight the common misdiagnoses because failure to correctly diagnose could delay timely institution of treatment. Trauma or normal investigations do not exclude an underlying haematological malignancy. This rare diagnosis in the ER should always be considered when challenged with recurrent bony complaints.
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Affiliation(s)
- Wan-Yee Teo
- Department of Paediatric Medicine, Haematology Oncology Service, KK Women's and Children's Hospital, Singapore.
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van der Have N, Nath SV, Story C, Tapp H, Nicola C, Moore S, Sutton R, Revesz T. Differential diagnosis of paediatric bone pain: acute lymphoblastic leukemia. Leuk Res 2012; 36:521-3. [PMID: 22285505 DOI: 10.1016/j.leukres.2012.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 09/11/2011] [Accepted: 01/03/2012] [Indexed: 11/15/2022]
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Shiner EK, McLean T, Pang CS, Rouster-Stevens K. A 9-year-old girl with ankle, knee, and shoulder pain. Arthritis Care Res (Hoboken) 2012; 64:149-56. [PMID: 22213728 DOI: 10.1002/acr.20606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Erin K Shiner
- Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
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