Acute lymphoblastic leukemia presenting as arthritis

Department Of Pediatrics Cancer Hospital Aurangabad

A 11yrs old male child Jay Waghpanje with second degree consangious marriage came to GMCH Aurangabad on 4/6/16 with complaining of fever since 10-12 days. Pt was anaemic and had hepatospleenomegaly and had bilateral knee pain since 8-10 days. On investigation peripheral smear and bone marrow examination showed >80% lymphoblasts. Immunophenotype showed mature B-cell morphology. All necessary investigations are CSF examination done for detecting metastasis. Pt was on induction 1 chemotherapy protocol for acute ALL.

ALL is the most common childhood malignancy accounting one fourth of all childhood cancers. The peak incidence of childhood. ALL is between 2-5yrs and boys have higher rates than girls especially in adolescents with T cell ALL. The etiology remain unknown in majority of cases. ALL usually presents with anemia, lymphadenopathy, hepatospleenomegaly, petechiae or infections. Bone or joint pain may occure due to leukemic infiltration of bones or joints. Usually in children, bilateral knee acute arthritis of fleeting type as in this case is taken as rheumatic fever. The other differential for this case may be Rheumatoid arthritis, septic arthritis or bacterial origin. This is a case of leukemia presenting as bilateral knee arthritis. Clinician should always keep in mind this differential whenever treating arthritis.