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CASE REPORT
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| A case report and review of clinical and laboratory pointers of leukemia in children with bone pain |
| Elpis Mantadakis1, Anastassios Valsamidis1, Athanassios Chatzimichael1 |
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1Department of Pediatrics, Democritus University of Thrace and University General District Hospital of Alexandroupolis, Thrace, Greece.
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doi:10.5348/ijcri-2010-12-9-CR-1
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Address correspondence to: Elpis Mantadakis Assistant Professor of Pediatrics Democritus University of Thrace and University General District Hospital of Alexandroupolis 6th Kilometre Alexandroupolis-Makris 68 100 Alexandroupolis Thrace, Greece. Phone: +30-25510-74411 Fax: +30-25510-30340 E-mail: emantada@med.duth.gr |
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| How to cite this article: |
| Mantadakis E, Valsamidis A, Chatzimichael A. A case report and review of clinical and laboratory pointers of leukemia in children with bone pain. International Journal of Case Reports and Images 2010;1(4):1-6. |
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Abstract
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Introduction: About 20-30% of children with acute lymphoblastic leukemia (ALL) present with bone pain, mainly in the lower extremities that can lead to limping or refusal to walk. These children suffer almost exclusively from B-precursor ALL and often present with a nearly normal complete blood count with few or no circulating lymphoblasts. Moreover, they are frequently misdiagnosed as suffering from juvenile arthritis. Case Report: We present case of a 5-year-old boy with mild skeletal complaints for one month who was diagnosed with ALL despite a normal physical examination and minimally affected complete blood count (mild anemia and lymphocytosis alone, with a normal platelet count). Conclusion: Children with ALL and musculoskeletal complaints may have a deceptively normal physical examination at presentation, absence of circulating blasts, and few if any abnormalities on the initial hemogram. Clinical and laboratory pointers to leukemia include bone tenderness or pain, especially if nocturnal and non-articular, anemia of any degree, low-normal leukocytes with relative lymphocytosis, red cell macrocytosis, low-normal platelet counts, especially when associated with elevated erythrocyte sedimentation rate and increased serum LDH. Extreme care is needed in the clinical and laboratory evaluation of children with leukemia and skeletal complaints in order not to miss the underlying diagnosis, misdiagnose juvenile arthritis and/or administer corticosteroids. | |
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Key Words:
Leukemia, Juvenile arthritis, Skeletal complaints, Differential diagnosis
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Author Contributions:
Elpis Mantadakis - Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Anastassios Valsamidis - Conception and design, Acquisition of data, Analysis and interpretation of data , Drafting of the article, Final approval of the version to be published Athanassios Chatzimichael - Conception and design, Acquisition of data, Analysis and interpretation of data , Drafting of the article , Final approval of the submitted version |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
The author(s) declare no conflict of interests. |
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Copyright:
© Elpis Mantadakis et. al. 2010; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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