J Korean Rheum Assoc.  2009 Jun;16(2):144-149. 10.4078/jkra.2009.16.2.144.

A Case of Adult Acute Myeloid Leukemia Presenting with Musculoskeletal Manifestations

Affiliations
  • 1Department of Physical Medicine and Rehabilitation, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea. hubbub95@korea.com

Abstract

Leukemia is a heterogenous group of neoplasms that arise from the malignant transformation of hematopoietic cells. The usual presentation is one of lethargy, pallor, fever, purpura, bleeding, etc, and all this is secondary to a decrease in the production of normal blood components. However, leukemia often manifests with musculoskeletal symptoms without a systemic presentation. Musculoskeletal symptoms that precede the recognition of leukemia are much less frequent in adults as compared to those in children, and this causes diagnostic confusion and a delayed diagnosis. We describe here a case of adult acute myeloid leukemia in which pain and weakness of the limbs were the main manifestations and these were suspected as being symptoms of musculoskeletal disease.

Keyword

Leukemia; Musculoskeletal manifestations

MeSH Terms

Adult
Child
Delayed Diagnosis
Extremities
Fever
Hemorrhage
Humans
Lethargy
Leukemia
Leukemia, Myeloid, Acute
Musculoskeletal Diseases
Pallor
Purpura

Figure

  • Fig. 1. Coronal T1-weighted spin-echo image of the metaphysis and diaphysis of the right humerus shows a diffuse low signal intensity due to marrow infiltration (A) and (B) the corresponding fat-suppressed T2-weighted image shows multiple areas with a high signal intensity.

  • Fig. 2. Whole body bone scan with Tc-99m HDP shows hot uptake of both proximal humeri, femurs, and the left tibia.

  • Fig. 3. Bone marrow aspirate findings (Wright-Giemsa stain, ×1,000). Leukemic cells reveal large-sized, coarse nuclear chromatin with distinct nucleoli and scant basophilic cytoplasm.


Reference

References

1. Georges JB, Ceulaer KD. Osteoarticular disorders of haematological origin. Baillieres Best Pract Res Clin Rheumatol. 2000; 14:307–23.
2. Thomas LB, Forkner CE, Frei E, Besse BE, Stabenau JR. The skeletal lesions of acute leukemia. Cancer. 1961; 14:608–21.
Article
3. Bowen RJ, Andrisani D, Miller K. Extremity pain in a child: a case report of leukemia. Del Med J. 1999; 71:293–6.
4. Rogalsky RJ, Black GB, Reed MH. Orthopaedic manifestations of leukemia in children. J Bone Joint Surg Am. 1986; 68:494–501.
Article
5. Sinigaglia R, Gigante C, Bisinella G, Varotto S, Zan-esco L, Turra S. Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop. 2008; 28:20–8.
Article
6. Gur H, Koren V, Ehrenfeld M, BenBassat I, Sidi Y. Rheumatic manifestations preceding adult acute leukemia: characteristics and implication in course and prognosis. Acta Haematol. 1999; 101:1–6.
Article
7. Marsh WL Jr, 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.
Article
8. 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.
Article
9. Jonsson OG, Sartain P, Ducore JM, Buchanan GR. Bone pain as an initial symptom of childhood acute lymphoblastic leukemia: association with nearly normal hematologic indexes. J Pediatr. 1990; 117:233–7.
Article
10. Wallendal M, Stork L, Hollister JR. The discriminating value of serum lactate dehydrogenase levels in children with malignant neoplasms presenting as joint pain. Arch Pediatr Adolesc Med. 1996; 150:70–3.
11. Barbosa CM, Nakamura C, Terreri MT, Lee ML, Pet-rilli AS, Hilário MO. Musculoskeletal manifestations as the onset of acute leukemias in childhood. J Pediatr (Rio J). 2002; 78:481–4.
Article
12. Jeong KE, Lee HJ, Song KS, Kim HS, Kang CM. Clinical manifestation of childhood acute leukemia with bone involvement. J Korean Pediatr Soc. 2000; 43:806–13.
13. Bernard EJ, Nichollas WD, Howman-Giles RB, Kelly SJ, Uren RF. Patterns of abnormality on bone scans in acute childhood leukemia. J Nucl Med. 1998; 39:1983–6.
14. Choi HS, Park JM, Sohn HS, Chung SK, Kim CY, Bahk YW, et al. Bone scintigraphic findings in leukemic patients. Korean J Nucl Med. 1992; 26:101–5.
15. Révész T, Kardos G, Kajtár P, Schuler D. The adverse effect of prolonged prednisolone pretreatment in children with acute lymphoblastic leukemia. Cancer. 1985; 55:1637–40.
Article
Full Text Links
  • JKRA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr