Musculoskeletal manifestations in children with acute lymphoblastic leukemia (ALL)

Abstract

Introduction: Musculoskeletal pain is prevalent in children. The causes are: trauma, growing pains, pressing as infections. However, it is necessary to expand the differential diagnosis to neoplastic diseases, with ALL, being the most common in the latter process. The objective is to evaluate the musculoskeletal manifestations of ALL in children to define an epidemiological profile of the manifestations.
Materials and methods: A case series study was carried out between February 2010 and February 2011 including 44 patients admitted to the Hematology Service of the Pediatric Hospital Fundación La Misericordia, Bogotá. We evaluated the clinical manifestations in patients between 0 and 18 years of age with diagnosis of ALL. The following variables were recorded: age, gender, anatomic location of signs and symptoms, relation with radiographic findings, haemoglobin levels, C-reactive protein, leukocytes, lactate dehydrogenase (LDH).
Results: We found graeter affection in male children, mean age 7.7 years (greater number 0 to 5 years) preponderant phenotype B and associated with greater musculoskeletal symptomatology. The majority presented normal leukocyte numbers, high LDH levels directly proportional to symptoms. Imaging findings in decreasing order were osteopenia, metaphyseal lines, column infiltrates, permeative patterns and periosteal reactions.
Conclusion: Our findings are similar to other studies. ALL is related to musculoskeletal manifestations (a common reason for orthopedic, pediatric and emergency consultations) being masked by other processes prevalent in pediatric patients. It is important to approach it as a differential diagnosis, since the prognosis of the disease depends on early diagnosis.
Level of evidence: IV. Case study series