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Yagupsky P. The Past, Present, and Future of Kingella kingae Detection in Pediatric Osteoarthritis. Diagnostics (Basel) 2022; 12:diagnostics12122932. [PMID: 36552939 PMCID: PMC9777514 DOI: 10.3390/diagnostics12122932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
As a result of the increasing use of improved detection methods, Kingella kingae, a Gram-negative component of the pediatric oropharyngeal microbiota, is increasingly appreciated as the prime etiology of septic arthritis, osteomyelitis, and spondylodiscitis in children aged 6 to 48 months. The medical literature was reviewed to summarize the laboratory methods required for detecting the organism. Kingella kingae is notoriously fastidious, and seeding skeletal system samples onto solid culture media usually fails to isolate it. Inoculation of synovial fluid aspirates and bone exudates into blood culture vials enhances Kingella kingae recovery by diluting detrimental factors in the specimen. The detection of the species has been further improved by nucleic acid amplification tests, especially by using species-specific primers targeting Kingella kingae's rtxA, groEL, and mdh genes in a real-time PCR platform. Although novel metagenomic next-generation technology performed in the patient's plasma sample (liquid biopsy) has not yet reached its full potential, improvements in the sensitivity and specificity of the method will probably make this approach the primary means of diagnosing Kingella kingae infections in the future.
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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410500, Israel
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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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Kesarapu S, Vangala N, Uppin SG, Uppin MS, Paul TR, Rajasekhar L. Acute Leukemia Presenting with Musculoskeletal Manifestations: A Case Series. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_113_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Introduction: Leukemia is the most common childhood malignancy accounting for 30%–40% of cases. Acute lymphoblastic leukemia is the most common leukemia in children with peak incidence in 2–6 years of age. The present study aims to assess the incidence of acute leukemia in patients presenting with musculoskeletal manifestations. Materials and Methods: This is a retrospective study conducted in a tertiary center from January 2014 to December 2018. A total of 63 children presented with musculoskeletal manifestations and underwent bone marrow examination. Based on final marrow diagnosis, the study group was divided into leukemic and nonleukemic groups. Results: Fever was the most common presenting complaint and was present in all the patients of both the groups. The occurrence of hepatosplenomegaly was comparatively higher in the leukemic group than in patients with juvenile idiopathic arthritis (JIA). The predominant type of arthritis was oligoarticular (68.15%) in the leukemic group and polyarticular (77.27%) in the nonleukemic group. Rheumatoid rash was noted in 20% of JIA patients, and none of the patients in the leukemic group had rash. The percentages of anemia, leukopenia, and thrombocytopenia were statistically higher in leukemia patients than in JIA patients. Conclusion: Bone marrow studies are a prerequisite in diagnosing leukemias. However, based on the presence of few atypical clinical and laboratory features, leukemia can be excluded in JIA patients.
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Affiliation(s)
- Swetha Kesarapu
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Navatha Vangala
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shantveer G Uppin
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Tara Roshni Paul
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Liza Rajasekhar
- Department of Rheumatology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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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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Abstract
Juvenile idiopathic arthritis (JIA) encompasses a complex group of disorders with arthritis as a common feature. This article provides the pediatrician with a review of the epidemiology, classification, clinical manifestations, and complications of JIA. It also provides an update on the current understanding of the cause of JIA and recent developments in management and a recent review of the long-term outcome in JIA.
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Affiliation(s)
- Peter J Gowdie
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Survival rates of children with acute lymphoblastic leukemia presenting to a pediatric rheumatologist in the United States. J Pediatr Hematol Oncol 2011; 33:424-8. [PMID: 21572344 DOI: 10.1097/mph.0b013e31820998c4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 30% of pediatric acute lymphoblastic leukemia patients present with musculoskeletal symptoms and are often referred first to a pediatric rheumatologist. We examined the survival and causes of death of these patients presenting to a pediatric rheumatologist and compared the rates with that reported in the hematology-oncology literature. PROCEDURE We used the Pediatric Rheumatology Disease Registry, including 49,023 patients from 62 centers, newly diagnosed between 1992 and 2001. Identifiers were matched with the Social Security Death Index censored for March 2005. Deaths were confirmed by death certificates, referring physicians, and medical records. Causes of death were derived by chart review or from the death certificate. RESULTS There were 7 deaths of 89 patients (7.9%, 95% confidence interval: 3.9%-15.4%) with acute lymphoblastic leukemia with a 5-year survival rate of 95.5% (88.3 to 98.3) and 10-year survival rate of 89.8% (79.0% to 95.2%). The causes of death were sepsis (bacterial and/or fungal) in 4 (57%) patients, the disease in 2 (29%) and post bone-marrow transplantation in 1 (14%). CONCLUSION The overall survival of patients with acute lymphoblastic leukemia seen first by pediatric rheumatologists is higher than the range reported in the pediatric oncology literature for the same period of diagnosis.
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Tamashiro MS, Aikawa NE, Campos LMA, Cristofani LM, Odone-Filho V, Silva CA. Discrimination of acute lymphoblastic leukemia from systemic-onset juvenile idiopathic arthritis at disease onset. Clinics (Sao Paulo) 2011; 66:1665-9. [PMID: 22012035 PMCID: PMC3180165 DOI: 10.1590/s1807-59322011001000001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 03/21/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess clinical and laboratory features that differentiate acute lymphoblastic leukemia from systemic juvenile idiopathic arthritis at disease onset. METHODS Fifty-seven leukemia patients with musculoskeletal involvement, without blasts on peripheral blood and without glucocorticoid therapy at disease onset and 102 systemic juvenile idiopathic arthritis patients (International League of Associations for Rheumatology criteria) were retrospectively evaluated. The following features were examined: fever, rheumatoid rash, arthritis, limb pain, hepatomegaly, splenomegaly, pericarditis, myocarditis, pleuritis, weight loss, bleeding, anemia, leukopenia, neutropenia, thrombocytopenia, erythrocyte sedimentation rate, and lactic dehydrogenase levels. RESULTS The median age at disease onset was significantly higher in leukemia patients than in those with systemic-onset juvenile idiopathic arthritis (5.8 vs. 3.8 years). In addition, the frequencies of limb pain, hepatomegaly, weight loss and hemorrhagic manifestations were significantly higher in leukemia patients than in systemic-onset juvenile idiopathic arthritis patients (70% vs. 1%, 54% vs. 32%, 30% vs. 8%, and 9% vs. 0%, respectively). Likewise, the frequencies of anemia, leukopenia, neutropenia, thrombocytopenia and high lactic dehydrogenase levels were statistically higher in leukemia patients than in patients with systemic-onset juvenile idiopathic arthritis (88% vs. 57%, 39% vs. 1%, 60% vs. 1%, 77% vs. 1%, and 56% vs. 14%, respectively). Remarkably, multivariate analysis revealed that limb pain (OR = 553; 95% CI = 46.48-6580.42) and thrombocytopenia (OR = 754.13; 95% CI = 64.57-8806.72) were significant independent variables that differentiated leukemia from systemic-onset juvenile idiopathic arthritis. The R2 of the Nagelkerke test was 0.91, and the Kaplan-Meier survival curves were similar for acute lymphoblastic leukemia patients with and without limb pain. CONCLUSION Our study emphasizes the importance of investigating leukemia in patients presenting with musculoskeletal manifestations and, in particular, limb pain associated with thrombocytopenia.
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Affiliation(s)
- Mirian S Tamashiro
- Pediatric Rheumatology Unit, Faculdade de Medicina, Instituto da Criança, Universidade de São Paulo, São Paulo, Brazil
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Arthritic presentation of childhood malignancy: beware of normal blood counts. Rheumatol Int 2010; 31:827-9. [PMID: 20686770 DOI: 10.1007/s00296-010-1584-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
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Mallepalli J, Gedalia A. A child with severe joint pain. Clin Pediatr (Phila) 2010; 49:605-7. [PMID: 18626100 DOI: 10.1177/0009922808321446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Marwaha RK, Kulkarni KP, Bansal D, Trehan A. Acute lymphoblastic leukemia masquerading as juvenile rheumatoid arthritis: diagnostic pitfall and association with survival. Ann Hematol 2009; 89:249-54. [PMID: 19727722 DOI: 10.1007/s00277-009-0826-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 08/20/2009] [Indexed: 10/20/2022]
Abstract
Acute lymphoblastic leukemia (ALL) often presents with osteoarthritic manifestations which may lead to misdiagnosis with juvenile rheumatoid arthritis (JRA). This study was designed to identify ALL patients with initial diagnosis of JRA, compare their clinicolaboratory characteristics and outcome with other ALL patients treated at our center. Case records of 762 patients with ALL were analyzed. Information regarding the clinical-demographic profile, therapy and outcome were recorded. Of the children, 49 (6.4%) had initial presentation mimicking JRA. Asymmetric oligoarthritis was the most common pattern of joint involvement. Majority presented with fever, pallor, arthritis, night pain, and bone pain. None of the routine prognostic factors including age, gender, lymphadenopathy, hepatosplenomegaly, total leukocytes count (TLC), and platelet count were significantly associated with relapse/death. The mean symptom-presentation interval (SPI), hemoglobin was significantly higher whilst the TLC was significantly lower in these patients compared to other ALL patients. The 5 year overall-survival was better than other patients with ALL (p = 0.06, by logrank test). Significantly longer SPI in these patients underscores the need for prompt and early investigations to rule out ALL in patients of JRA with atypical features and pointers of ALL. Children with ALL-mimicking JRA may belong to a subgroup of ALL with a better prognosis.
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Affiliation(s)
- Ram Kumar Marwaha
- Division of Pediatric Hematology-Oncology, Advanced Pediatric Center, PGIMER, Sec 12, Pin: 160012, Chandigarh, India.
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Gupta D, Singh S, Suri D, Ahluwalia J, Das R, Varma N. Arthritic presentation of acute leukemia in children: experience from a tertiary care centre in North India. Rheumatol Int 2009; 30:767-70. [PMID: 19633857 DOI: 10.1007/s00296-009-1064-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Accepted: 07/12/2009] [Indexed: 11/29/2022]
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Janic D, Loncarevic S, Krstovski N, Dokmanovic L, Lazic J, Rodic P. Bone marrow findings in juvenile idiopathic arthritis. Pediatr Hematol Oncol 2008; 25:575-81. [PMID: 18728977 DOI: 10.1080/08880010802258431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The diagnosis of juvenile idiopathic arthritis (JIA) is an exclusion one due to heterogeneous clinical presentation and lack of specific laboratory tests. The authors investigated bone marrow of 25 untreated children with JIA at the onset of the disease. Bone marrow smears were evaluated for cell populations as well as myelodysplastic features and compared to two control groups. The characteristic of bone marrow in JIA was myeloid hyperplasia and elevated plasmocyte count. There was no difference between JIA patients and control groups in terms of myelodysplastic features. These findings can be helpful in explaining hematological alterations in JIA.
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Abstract
BACKGROUND In children, acute leukemia (AL) at presentation can mimic several orthopaedic pathologies, so that a variable delay of the correct diagnosis is often reported. METHODS To define more clearly the clinical and radiological musculoskeletal manifestations of leukemia in children, 122 affected children referred from 1984 to 1999 to our Pediatric Onco-Hematologic Clinic were retrospectively reviewed. Average age at diagnosis was 6.6 years (from 7 months to 17 years). Seventy-three (60%) were boys and adolescent boys, 49 (40%) were girls and adolescent girls. One hundred two (83.6%) had acute lymphoblastic leukemia, 20 (16.4%) had acute myeloid leukemia. The mean follow-up was 8.2 years for the 104 survivors and 2.5 years for the 18 nonsurvivors. The chi2 test was used to perform the statistical analyses. RESULTS At presentation, complaints related to the musculoskeletal system were frequent (38.3%), including pain (34.4%), functional impairment (22.9%), limping (12.3%), swelling (10.6%), and joint effusion (5.7%). At presentation, 40.2% of children had at least 1 radiographic abnormality. In order, they were osteolysis (13.1%), metaphyseal bands (9.8%), osteopenia (9%), osteosclerosis (7.4%), permeative pattern (5.7%), pathological fractures (5.7%), periosteal reactions (4.1%), and mixed lysis-sclerosis lesions (2.5%). Different from previous reports, late radiographic lesions were uncommon (5.7%), probably because of milder newer medication protocols. They included avascular necrosis (3.3%), vertebral collapses (1.6%), and osteolysis (0.8%). CONCLUSIONS Both clinical and radiological changes had various and no uniform localization. Poor correlation was found between symptoms and radiological lesions. Survival rates in children with AL were 95.8% at 1 year, 89.6% at 3 years, 85.8% at 5 years, and 83.4% at 10 and at 13 years. Radiographic abnormalities (P = 0.400), type of leukemia (P = 0.291), sex (P = 0.245), and white blood cell count at presentation (P = 0.877) were not prognostic factors. The presence of multiple bone lesions did not affect the survival rate (P=0.632). As early diagnosis significantly decreases morbidity and mortality of AL, the orthopaedist should suspect AL in any child with unexplained persistent skeletal pain or radiographic alterations. Accurate history, general physical examination, and complete blood cell count tests should address the suspicion, which is confirmed by a peripheral and/or iliac crest bone marrow biopsy.
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Robazzi TCMV, Barreto JHS, Silva LR, Santiago MB, Mendonça N. Osteoarticular manifestations as initial presentation of acute leukemias in children and adolescents in Bahia, Brazil. J Pediatr Hematol Oncol 2007; 29:622-6. [PMID: 17805037 DOI: 10.1097/mph.0b013e3181468c55] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was to determine the prevalence and characteristics of the osteoarticular manifestations on initial clinical presentation of acute leukemias (ALs) on childhood in the state of Bahia, Brazil. MATERIALS AND METHODS This retrospective study assessed the medical records of 406 patients with AL from January 1995 to December 2004. RESULTS Acute lymphocytic leukemia (ALL) was diagnosed in 313 (77.1%) patients and acute myeloid leukemia (AML), in 93 (22.9%) patients, including 241 males (59.4%) and 165 females (40.6%). Age ranged from 9 months to 15 years (average: 6.18 y). The most common presenting features were fever (18.5%), musculoskeletal diffuse tenderness (15.0%), pallor (11.4%), and leg tenderness (5.7%). Prior referral to our center, the most frequent initial diagnosis was anemia (15.8%), leukemia (15.0%), amygdalitis (3.7%), and rheumatic fever (2.7%). Osteoarticular manifestations were found on 54.7% of the patients with AL, with a higher frequency among patients between 1 and 9 years of age (58.7%, P=0.0007). The presence of joint tenderness (16.2% in ALLx5.4% in AML), arthritis (26.6% in ALLx9.7 in AML), bone tenderness (26.1% in ALLx16.1% in AML), limb tenderness (49.5% in ALLx25.8% in AML), and antalgic gait (32.8% in ALLx9.7% in AML) had higher prevalence on ALL. The large joints, chiefly the knees (10.6%), ankles (9.4%), elbows (4.4%), and shoulders (3.6%) were more often affected. CONCLUSIONS AL should be considered on the differential diagnosis of osteoarticular symptoms of unknown etiology in children.
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Affiliation(s)
- Teresa Cristina Martins Vicente Robazzi
- Pediatric Rheumatology Unit at Hospital São Rafael, Fundação Monte Tabor, and Pediatric Gastroenterology and Hepatology Service of Federal University of Bahia, Bahian Medical and Public Health School, Salvador, Bahia, Brazil.
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Jones OY, Spencer CH, Bowyer SL, Dent PB, Gottlieb BS, Rabinovich CE. A multicenter case-control study on predictive factors distinguishing childhood leukemia from juvenile rheumatoid arthritis. Pediatrics 2006; 117:e840-4. [PMID: 16651289 DOI: 10.1542/peds.2005-1515] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Acute lymphocytic leukemia (ALL) often presents with musculoskeletal concerns such as pain or swelling, even before appearance of blasts in the peripheral blood. Such presentation may lead to misdiagnosis of a child with juvenile rheumatoid arthritis (JRA). This study was designed to identify the predictive factors for leukemia using basic clinical and laboratory information. METHODS A retrospective chart review was performed using a simple questionnaire to compare the clinical and laboratory findings present during the initial visit to a pediatric rheumatology clinic for 277 children who were ultimately diagnosed with either JRA (n = 206) or ALL (n = 71). Sensitivity and specificity analysis of a variety of parameters, both singly and in combination, was performed to identify predictive value for ALL. RESULTS The majority (75%) of children with ALL did not have blasts in the peripheral blood at the time of evaluation by pediatric rheumatologists. In children presenting with unexplained musculoskeletal complaints, the 3 most important factors that predicted a diagnosis of ALL were low white blood cell count (< 4 x 10(9)/L), low-normal platelet count (150-250 x 10(9)/L), and history of nighttime pain. In the presence of all 3, the sensitivity and specificity for a diagnosis of ALL were 100% and 85%, respectively. Other findings, including antinuclear antibody, rash, and objective signs of arthritis, were not helpful in differentiating between these diagnoses because they occurred at similar rates in both groups. CONCLUSIONS When a child develops new-onset bone-joint complaints, the presence of subtle complete blood count changes combined with nighttime pain should lead to consideration of leukemia as the underlying cause.
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Affiliation(s)
- Olcay Y Jones
- Department of Pediatric Rheumatology, Children's National Medical Center, George Washington University, Washington, DC 20010, USA.
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Abstract
The care and study of children with rheumatic diseases began slowly in the 19th century, with the most attention centered on rheumatic fever. Other rheumatic diseases of children received little attention until the 1940s. Rheumatic diseases taken together remain a significant cause of chronic illness in children throughout the world. A number of other conditions that masquerade as rheumatic diseases in children also demand recognition and management. Although ultimate causes and cures of childhood rheumatic diseases remain elusive, advances in therapy have improved the outlook for affected children, and advances in biomedical research are adding to our basic understanding of the disease process involved. Pediatric rheumatology has become a well-organized, although underpopulated, specialty that enhances recognition and care of affected children and contributes to basic research knowledge in infectious disease, immunology, and genetics. This review focuses most prominently on the early history of pediatric rheumatology and its development as a specialty. The recent burgeoning of new biomedical science and new means of treatment will be better told in the historical perspective of years to come.
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Affiliation(s)
- Jane G Schaller
- International Pediatric Association, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
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17
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Richardson C, Singer JI, Springer B. Subacute leg pain. Pediatr Emerg Care 2005; 21:387-90. [PMID: 15942519 DOI: 10.1097/01.pec.0000166732.70847.0e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Candie Richardson
- Department of Emergency Medicine, Wright State University School of Medicine, Dayton, OH 45429, USA
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Kobayashi D, Satsuma S, Kamegaya M, Haga N, Shimomura S, Fujii T, Yoshiya S. Musculoskeletal conditions of acute leukemia and malignant lymphoma in children. J Pediatr Orthop B 2005; 14:156-61. [PMID: 15812284 DOI: 10.1097/01202412-200505000-00003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We retrospectively reviewed 16 patients who presented to hospitals with orthopaedic complaints. Twelve patients experienced initial symptoms in the extremities and four patients had back pain. The leukocyte count was elevated in one patient, decreased in two patients, and normal in 13 patients. On radiographic examination, osteopenia was observed in 10 patients, osteolytic lesions were observed in five, and pathologic fractures were observed in five. Because the initial presentation of patients with leukemia often involves the musculoskeletal system, orthopaedists need to recognize the symptoms of this disease to avoid misdiagnosis and to expedite the initiation of appropriate potentially lifesaving treatment.
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Affiliation(s)
- Daisuke Kobayashi
- Department of Orthopaedic Surgery, Kobe Children's Hospital, Kobe, Japan.
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Gonçalves M, Terreri MTRA, Barbosa CMPL, Len CA, Lee L, Hilário MOE. Diagnosis of malignancies in children with musculoskeletal complaints. SAO PAULO MED J 2005; 123:21-3. [PMID: 15821811 DOI: 10.1590/s1516-31802005000100005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Musculoskeletal complaints may be associated with neoplasias as an initial manifestation of the disease. When these symptoms predominate at the onset of the disease, the differential diagnosis includes several rheumatic diseases. OBJECTIVE To assess the frequency, clinical features and types of cancer manifested in children presenting with musculoskeletal complaints over a seven-year period. TYPE OF STUDY Retrospective. SETTING Discipline of Allergy, Clinical Immunology and Rheumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina. METHODS The medical records of patients with musculoskeletal complaints and final diagnosis of malignant disease were reviewed. The data collected were: age when symptoms initially presented, age at diagnosis, clinical features presented, laboratory findings, and the initial and final diagnoses. RESULTS A final diagnosis of cancer was found in nine out of 3,528 patients (0.25%) whose initial symptom was musculoskeletal pain. The mean time between disease onset and final diagnosis was five months. The most common features presented were pauciarticular arthritis or arthralgia involving the large joints. Juvenile rheumatoid arthritis was the most frequent initial diagnosis, in four out of nine patients. Anemia was the most frequent initial hematological change. Six out of eight patients had an increased erythrocyte sedimentation rate. The lactate dehydrogenase level was raised in five out of eight patients. The malignancies found included acute lymphocytic leukemia, acute myeloid leukemia, lymphoma, neuroblastoma and Ewing's sarcoma. DISCUSSION The frequency of neoplasia in patients with musculoskeletal pain resembled reports in the literature. Consumptive symptoms were not the warning signal in most of our patients. In subsidiary tests, progressive anemia was the most common finding, although the peripheral blood cell count may continue to be normal for weeks or months after symptom onset. CONCLUSION Malignancy always needs to be ruled out in cases of children with musculoskeletal complaints. Uncharacteristic clinical manifestations and nonspecific laboratory tests may cause difficulty in the final diagnosis, and rigorous investigation should be performed.
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Affiliation(s)
- Marcela Gonçalves
- Department of Pediatrics, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
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Connolly LP, Connolly SA. Skeletal scintigraphy in the multimodality assessment of young children with acute skeletal symptoms. Clin Nucl Med 2003; 28:746-54. [PMID: 12972997 DOI: 10.1097/01.rlu.0000082663.54359.d9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The authors review the scintigraphic manifestations of acute osteomyelitis, septic arthritis, transient synovitis, Legg-Calvé-Perthes disease, fractures of toddlers, and some systemic conditions that cause skeletal symptoms during childhood. They offer suggestions regarding incorporation of skeletal scintigraphy into a multimodality approach for assessing children with skeletal symptoms.
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Affiliation(s)
- Leonard P Connolly
- Division of Nuclear Medicine, Department of Radiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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21
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Erdöl H, Elmas R, Alioglu Z, Imamoglu HI. Retinopathy due to juvenile polymyositis. J Pediatr Ophthalmol Strabismus 2001; 38:41-3. [PMID: 11201918 DOI: 10.3928/0191-3913-20010101-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- H Erdöl
- Department of Ophthalmology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
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22
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Trapani S, Grisolia F, Simonini G, Calabri GB, Falcini F. Incidence of occult cancer in children presenting with musculoskeletal symptoms: a 10-year survey in a pediatric rheumatology unit. Semin Arthritis Rheum 2000; 29:348-59. [PMID: 10924020 DOI: 10.1053/sarh.2000.5752] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the frequency and types of cancer found in children presenting to our Unit with musculoskeletal symptoms over a 10-year period. METHODS The medical records of patients with musculoskeletal symptoms and a final diagnosis of cancer were reviewed. In each case age, gender, presenting symptoms, laboratory data, diagnostic procedures, provisional and final diagnoses, and time between clinical onset and correct diagnosis were reviewed. RESULTS An underlying neoplasia was found in 10 of 1,254 patients (<1%) complaining of musculoskeletal symptoms. The types of malignancies found included acute lymphocytic leukemia (ALL) (6 cases), lymphoma (2 cases), neuroblastoma (1 case), and Ewing's sarcoma (1 case). The mean time between disease onset and final diagnosis was 3.2 months. The most common presenting feature was monoarthritis, involving the larger joints such as the elbows, knees or ankles. Juvenile idiopathic arthritis (JIA) was the most frequent provisional diagnosis. In the preliminary hematologic evaluation, eight patients had an increased erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) value. White blood cell (WBC) count was normal in almost all children, with a normal differential count. Lactic dehydrogenase (LDH) was raised in all children. Bone marrow aspirates and lymph node or bone biopsies were necessary to reach the final diagnosis. CONCLUSIONS A malignancy should always be excluded in children with musculoskeletal symptoms, especially when the clinical pattern is not characteristic of a specific rheumatic disease. Routine laboratory tests may be misleading. The simultaneous presence of high LDH or alpha-hydroxybutyric dehydrogenase (alpha-HBDH) levels and raised ESR or CRP, even with normal blood cell counts, should lead to additional investigations. RELEVANCE All patients presenting with arthritis or other musculoskeletal symptoms should have a thorough clinical examination. Disproportionate pain levels and an atypical pattern of "arthritis," especially in the presence of systemic manifestations, suggest a possible underlying malignancy.
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Affiliation(s)
- S Trapani
- Department of Pediatrics, A. Meyer Hospital, University of Florence, Italy
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23
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 14-1999. A nine-year-old girl with fever and cervical lymphadenopathy. N Engl J Med 1999; 340:1491-7. [PMID: 10320389 DOI: 10.1056/nejm199905133401908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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24
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Abstract
OBJECTIVE Children ultimately diagnosed with malignancy are referred to pediatric rheumatology clinics with provisional rheumatic diagnoses. We aimed to distinguish the features in these patients that lead to the correct diagnosis of malignancy. STUDY DESIGN A retrospective review of the case records of 29 children (19 boys and 10 girls, aged 1 to 15.5 years) with malignancy who were referred to 2 pediatric rheumatology centers between 1983 and 1997. RESULTS The suspected diagnoses on referral were: juvenile rheumatoid arthritis (12), nonspecific connective tissue disease (4), discitis (3), spondyloarthropathy (3), systemic lupus erythematosus (2), Kawasaki disease (2), Lyme disease (1), mixed connective tissue disease (1), and dermatomyositis (1). The final diagnoses were leukemia (13), neuroblastoma (6), lymphoma (3), Ewing's sarcoma (3), ependymoma (1), thalamic glioma (1), epithelioma (1), and sarcoma (1). Patients had features typical of many rheumatic disorders including musculoskeletal pains (82%), fever (54%), fatigue (50%), weight loss (42%), hepatomegaly (29%), and arthritis (25%). Features that were suggestive of malignancy included nonarticular "bone" pain (68%), back pain as a major presenting feature (32%), bone tenderness (29%), severe constitutional symptoms (32%), clinical features "atypical" of most rheumatic disease (48%), and abnormal initial investigations (68%). The atypical features included night sweats (14%), ecchymoses and bruising (14%), abnormal neurologic signs (10%), abnormal masses (7%), and ptosis (3%). Initial investigations with abnormal findings included complete blood count/smear (31%), discordant erythrocyte sedimentation rate and platelet count (28%), elevated lactate dehydrognease level (24%), plain skeletal x-ray films (28%), bone scan (21%), and abdominal ultrasonography (17%). Findings of investigations done before referral to the rheumatology clinic were not recognized as abnormal in 11 (40%) patients. CONCLUSIONS Patients with a diverse group of malignancies, other than leukemia, may present to the pediatric rheumatologist. Pediatric care providers should be familiar with typical features of childhood rheumatic disorders, and rheumatic diagnoses should be reevaluated in the presence of any atypical or discordant clinical features.
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Affiliation(s)
- D A Cabral
- Division of Pediatric Rheumatology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Abstract
Nine patients who presented to our institution with the chief complaint of a limp and no history of trauma were subsequently diagnosed with leukemia. A review of these patients identified clinical and laboratory findings that helped to establish the diagnosis. The presence of an antalgic gait with complaints of pain of variable intensity and duration, an irritable hip or knee, a mild to moderate elevation in body temperature, lymphadenopathy, hepatosplenomegaly, an increased erythrocyte sedimentation rate, thrombocytopenia, anemia, decreased neutrophils, increased lymphocytes, or blast cells on the peripheral blood smear should cause the physician to suspect leukemia in a limping child. Bone marrow biopsy confirms the diagnosis.
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Affiliation(s)
- H R Tuten
- Georgia Sports Medicine and Orthopaedic Clinic, Tifton, USA
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26
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Schneider R, Laxer RM. Systemic onset juvenile rheumatoid arthritis. BAILLIERE'S CLINICAL RHEUMATOLOGY 1998; 12:245-71. [PMID: 9890097 DOI: 10.1016/s0950-3579(98)80018-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Systemic onset juvenile rheumatoid arthritis (SoJRA) accounts for 10-20% of all JRA, affecting males and females equally and occurring most frequently under the age of 5 years. It is characterized by arthritis, daily spiking fever, an evanescent rash, serositis and a variety of other extra-articular features. Exclusion of systemic infections, malignancies and connective tissue diseases is most important in establishing the diagnosis. The disease has a wide range of severity from a short monocyclic course to a prolonged chronic course with severe destructive arthritis in approximately one third of patients. Destructive arthritis, secondary amyloidosis and treatment complications including infections, osteoporosis, growth retardation and the macrophage activation syndrome account for the significant morbidity and mortality associated with the disease. Pharmacological management includes non-steroidal anti-inflammatory drugs, corticosteroids, methotrexate and an emerging role for cyclosporine A and cytotoxic drug therapy. Elucidation of the immunopathogenetic mechanisms may lead to new targeted therapy.
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Affiliation(s)
- R Schneider
- Department of Paediatrics, University of Toronto, Ontario, Canada
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27
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Falcini F, Bardare M, Cimaz R, Lippi A, Corona F. Arthritis as a presenting feature of non-Hodgkin's lymphoma. Arch Dis Child 1998; 78:367-70. [PMID: 9623403 PMCID: PMC1717542 DOI: 10.1136/adc.78.4.367] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Leukaemia can present with joint swelling in the absence of abnormal haematological findings. Arthritis as a presenting sign of lymphoma, however, is extremely rare. Three children with non-Hodgkin's lymphoma who had joint swelling at the onset of their disease are reported. Two cases showed histological features of anaplastic large cell lymphoma (Ki-1/CD30 positive), and one of angioimmunoblastic T cell lymphoma. In all patients the unusual presentation delayed correct diagnosis.
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Affiliation(s)
- F Falcini
- Department of Paediatrics, University of Florence, Italy
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28
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Abstract
Leukemic arthritis (LA) is an uncommon complication of both acute and chronic leukemias. LA occurs in 12% to 65% of childhood leukemia cases and 4% to 13% of adult leukemia cases. Involved joints usually are warm, swollen, and tender. This arthritis often is pauciarticular and preferentially involves large joints. LA occurs at any time during the course of leukemia and may be the presenting manifestation. Therefore, LA should be considered in the differential diagnosis of both adult and childhood rheumatic diseases. Establishing a diagnosis may be difficult and usually requires tissue biopsy. Newer immunochemical methods may help in the diagnosis of LA by demonstrating leukemic cells in synovial fluid. Therapy for the underlying leukemia is the treatment of choice. Decreasing joint pain often is the first sign of a clinical response to chemotherapy. A case report is presented and the literature on the subject is reviewed.
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Affiliation(s)
- T I Evans
- Department of Medicine, Medical College of Virginia/Virginia Commonwealth University, Richmond
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29
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Martin K, Davies EG, Axford JS. Fever of unknown origin in childhood: difficulties in diagnosis. Ann Rheum Dis 1994; 53:429-33. [PMID: 7944613 PMCID: PMC1005364 DOI: 10.1136/ard.53.7.429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We have described a child with systemic onset juvenile chronic arthritis who presented initially with fever of unknown origin. Treatment of a presumed infection led to a severe allergic response with Stevens-Johnson syndrome, renal failure and DIC. This reaction obscured the features of the underlying disease and delayed the diagnosis.
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Affiliation(s)
- K Martin
- Academic Rheumatology Group, St. George's Hospital Medical School, London, United Kingdom
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30
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Affiliation(s)
- R S Pinals
- Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick
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31
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32
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Ostrov BE, Goldsmith DP, Athreya BH. Differentiation of systemic juvenile rheumatoid arthritis from acute leukemia near the onset of disease. J Pediatr 1993; 122:595-8. [PMID: 8463908 DOI: 10.1016/s0022-3476(05)83543-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Many children with acute leukemia have musculoskeletal complaints and non-specific hematologic abnormalities. A total of 10 children with acute leukemia and 10 with systemic juvenile rheumatoid arthritis were compared to delineate which early features could differentiate these diagnoses. Attention to evolving hematologic abnormalities and musculoskeletal findings may expedite diagnosis of these diseases.
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Affiliation(s)
- B E Ostrov
- Pennsylvania State University Children's Hospital, Hershey Medical Center, Hershey, Pennsylvania
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33
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Rennie JA, Auchterlonie IA. Rheumatological manifestations of the leukaemias and graft versus host disease. BAILLIERE'S CLINICAL RHEUMATOLOGY 1991; 5:231-51. [PMID: 1756582 DOI: 10.1016/s0950-3579(05)80281-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bone and joint involvement in the leukaemias is discussed. Particular emphasis is placed upon osteoarticular presentations which may predate the haematological changes or divert attention from the primary pathology. A description of acute and chronic graft versus host disease is presented with particular emphasis on the rheumatological manifestations.
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34
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Abstract
Three cases of childhood acute lymphatic leukaemia masquerading as juvenile chronic arthritis are presented. All had symptoms and signs for at least 4 months before leukaemia was diagnosed and in two the full blood count was normal at presentation. The importance of a high index of suspicion is emphasized, particularly if the white cell count is low.
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Affiliation(s)
- A Bradlow
- Royal Berkshire Hospital, Reading, UK
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35
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Affiliation(s)
- D Gallagher
- Department of Orthopedics, Louisiana State University Medical Center, New Orleans
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36
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Armstrong J, Pomeroy M, Fennelly JJ, Cahalane S. Prognostic factors in childhood acute lymphoblastic leukaemia. Ir J Med Sci 1990; 159:40-3. [PMID: 2347677 DOI: 10.1007/bf02937246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
58 patients under the age of 14 years with acute lymphoblastic leukaemia were managed from 1971 to 1985. We analysed their overall survival from diagnosis to assess the prognostic significance of clinical and laboratory features present at diagnosis. Factors which were statistically significant included white blood count, platelet count, palpable lymph node enlargement, mediastinal widening on chest x-ray and palpable splenic enlargement. The purpose of this study was to identify that subset of patients which might have benefitted from more intensive treatment.
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Affiliation(s)
- J Armstrong
- Department of Oncology, Children's Hospital, Dublin
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37
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van Zanten TE, Golding RP, Taets van Amerongen AH, Pieters R, Veerman AJ. Nuclear magnetic resonance imaging of bone marrow in childhood leukaemia. Clin Radiol 1988; 39:77-81. [PMID: 3422184 DOI: 10.1016/s0009-9260(88)80349-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bone marrow infarction is known to occur in childhood leukaemia. Although it may be suspected on clinical grounds, radiographic evidence is infrequent. We present three cases in which magnetic resonance imaging demonstrated unexpectedly extensive bone marrow lesions and discuss the evidence that these lesions were due to bone marrow infarction.
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Affiliation(s)
- T E van Zanten
- Department of Radiodiagnosis, Free University Hospital, Amsterdam, The Netherlands
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38
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Abstract
Arthritis in children may result from many conditions. The rheumatic diseases, including juvenile rheumatoid arthritis, the spondyloarthropathies, rheumatic fever, lupus erythematosus, dermatomyositis, and the various vasculitis syndromes all can cause arthritis; these diseases are distinguished by their characteristic clinical appearances. Several nonrheumatic disorders such as infections, malignancies, congenital or genetic conditions, orthopedic conditions, and psychological disorders may closely simulate the various rheumatic diseases. The evaluation of children with arthritis rests chiefly on historical and physical findings; radiographs, laboratory tests, and occasionally biopsies also may be helpful. It is particularly important to identify specifically treatable diseases, such as bacterial infections or childhood malignancies, early and to avoid labeling nonrheumatic conditions as rheumatic. Accurate diagnosis of the various rheumatic disease syndromes is important for optimal therapy.
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39
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Abstract
There are many conditions that produce chronic arthritis in childhood, including JRA. The pitfalls associated with proper diagnosis involve underrecognition, misrecognition, and overrecognition of symptoms and signs.
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40
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 14-1986. A 28-month-old boy with recurrent arthralgia and multifocal osteolysis. N Engl J Med 1986; 314:973-81. [PMID: 2938006 DOI: 10.1056/nejm198604103141507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
MESH Headings
- Antigens, Neoplasm/analysis
- Arthritis, Juvenile/diagnosis
- Arthritis, Juvenile/etiology
- Bone Marrow/pathology
- Child, Preschool
- Diagnosis, Differential
- Fractures, Spontaneous/complications
- HLA-DR Antigens
- Histocompatibility Antigens Class II/analysis
- Humans
- Leukemia, Lymphoid/complications
- Leukemia, Lymphoid/diagnosis
- Leukemia, Lymphoid/pathology
- Lymph Nodes/pathology
- Male
- Metacarpus/injuries
- Necrosis
- Neprilysin
- Osteolysis, Essential/complications
- Preleukemia/diagnosis
- Time Factors
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41
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Abstract
A variety of musculoskeletal syndromes have been described in association with malignancy. The majority of such descriptions have dealt with the connective tissue disorder as a paraneoplastic syndrome, frequently the presenting feature of an otherwise occult malignancy. This may range from the well known syndrome of HOA, heralding lung cancer, to a lesser known association of pyogenic arthritis due to an unusual enteric pathogen, signaling colon cancer. Conversely, the connective tissue disorder may precede the malignancy, and by virtue of its pathophysiology or its therapy, foster the subsequent development of cancer. Awareness of these associations may lead to earlier cancer detection, and hence, potentially more effective therapy.
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42
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Brewer EJ, Gedalia A. Pitfalls in diagnosis of arthritis in children. Postgrad Med 1986; 79:305-20. [PMID: 3952048 DOI: 10.1080/00325481.1986.11699334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Arthritis occurs quite frequently in childhood. By clinically recognizing arthritis, using the proper studies for evaluation, and then carefully weighing the diagnostic evidence, the primary care physician will avoid the common pitfalls in diagnosis of chronic arthritis in children.
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43
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Monsees B, Destouet JM, Totty WG, McKeel D. Case report 349: "Leukemic arthritis" of elbow (leukemic infiltration and infarction distal end of humerus). Skeletal Radiol 1986; 15:154-9. [PMID: 3457473 DOI: 10.1007/bf00350211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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44
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Marsh WL, Bylund DJ, Heath VC, Anderson MJ. Osteoarticular and pulmonary manifestations of acute leukemia. Case report and review of the literature. Cancer 1986; 57:385-90. [PMID: 3942972 DOI: 10.1002/1097-0142(19860115)57:2<385::aid-cncr2820570233>3.0.co;2-l] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acute leukemia with bone or joint symptoms of sufficient magnitude to obscure and delay the correct diagnosis has been reported but is rarely mentioned in the recent literature, particularly in adults. The authors report an adult with rapidly fatal acute leukemia and a clinical course dominated by recurrent osteoarticular symptoms; osteoarticular symptoms preceded the diagnosis of leukemia by 3 months and delayed diagnosis and treatment. The correct diagnosis requires awareness of the osteoarticular manifestations of acute leukemia and examination of blood or bone marrow smear by an experienced observer; a biopsy specimen of bone or joint lesions or examination of cytocentrifuged synovial fluid may aid in diagnosis. The immediate cause of death in our patient was respiratory failure with prominent leukemic interstitial pulmonary infiltrates at autopsy; clinically significant leukemic pulmonary infiltrates have only rarely been reported. The authors review the literature on pulmonary and osteoarticular manifestations caused by acute leukemic infiltrates.
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45
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Musiej-Nowakowska E, Rostropowicz-Denisiewicz K. Differential diagnosis of neoplastic and rheumatic diseases in children. Scand J Rheumatol 1986; 15:124-8. [PMID: 3489289 DOI: 10.3109/03009748609102077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The early phase of the disease in 30 children referred to this Clinic with the diagnosis of rheumatic disease and whose condition was ultimately diagnosed as malignancy was analysed. A correct diagnosis was established after a period of 1-22 months. thus acute leukemia, non-Hodgkin's lymphoma, Hodgkin's disease and solid tumours were diagnosed in 13, 7, 3, 7 consecutive patients. It was demonstrated that in an early stage of neoplastic diseases, signs may occur which are typical also of rheumatic diseases. Fever, arthralgia or arthritis, hepatosplenomegaly, lymphadenopathy and signs of cardiac involvement predominated in the early picture of the disease. The need for diagnostic investigations ruling out neoplastic diseases has been emphasized. They should be performed even in children fulfilling the diagnostic criteria for rheumatic diseases. Attention has been called to the importance of carefully performed hematological and morphological analysis.
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46
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Abstract
The clinical and laboratory features of six children with arthritis as the presenting manifestation of acute leukemia are reviewed. Asymmetric arthritis involving the large joints of the extremities was the dominant clinical feature in all patients. Despite the presence of antinuclear antibody in three patients, other laboratory features, particularly hematologic abnormalities, served as clues to the diagnosis of leukemic arthropathy in most patients.
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47
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Abstract
As the presenting complaint in 7 per cent of pediatrician visits, pain in the limbs is a common problem in childhood. It is important that the diagnosis be made expeditiously. The authors review the possible organic cause of limb pain, as well as limb pain from conversion reactions and from growing pains, giving special attention to the differential diagnosis so that appropriate treatment for the pain can be initiated.
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48
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Saulsbury FT, Sabio H, Conrad D, Kesler RW, Levien MG. Acute leukemia with features of systemic lupus erythematosus. J Pediatr 1984; 105:57-9. [PMID: 6610737 DOI: 10.1016/s0022-3476(84)80359-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
MESH Headings
- Antibodies, Antinuclear/analysis
- Bone Marrow Examination
- Child
- Diagnosis, Differential
- Female
- Humans
- Leukemia, Lymphoid/blood
- Leukemia, Lymphoid/complications
- Leukemia, Lymphoid/diagnosis
- Leukemia, Lymphoid/drug therapy
- Lupus Erythematosus, Systemic/blood
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/etiology
- Prednisone/therapeutic use
- Vincristine/therapeutic use
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49
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Abstract
The clinical features of 25 children with Henoch-Schönlein purpura are presented, with particular emphasis on the cutaneous features. Although every patient exhibited purpura on the buttocks and lower extremities, it was preceded by a maculopapular or urticarial rash in nine. Moreover, cutaneous features were preceded by arthralgia or abdominal pain by up to two weeks in 40% of the patients. Other dominant clinical features included arthralgia in 84%, abdominal pain in 76%, nephritis in 44%, and gastrointestinal bleeding in 40%. Laboratory studies reflected the acute, systemic nature of the illness, but generally were of limited diagnostic value.
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50
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