Medullary Necrosis in Acute Leukemia Mimicking as JIA

Excerpt

A 14-y-old boy complaining of fever and large joint polyarthritis for last 2 mo, was referred to authors with a possibility of juvenile idiopathic arthritis (JIA). On examination, he had pallor, polyarthritis (involving both knee and elbow joints) and sternal tenderness. Radiograph showed a cortex-based lucent lesion in right femur (Fig. 1a). MRI revealed multiple other lesions suggestive of medullary necrosis (Fig. 1b & c). His initial full blood counts showed a hemoglobin of 11 g/L, total leucocyte count of 10600/mm³; neutrophils 45%, lymphocytes 49% and platelet count of 2.4 × 105/ mm³ and elevated inflammatory markers (CRP 124 mg/dl). Subsequently, repeat counts revealed falling hemoglobin (8 g/L), total leucocyte counts (4500/mm³; neutrophils 58%, lymphocytes 38%) and platelet count of 1.06 × 105/mm³, and peripheral smear showed 8% blasts, which unfolded the diagnosis of acute lymphoblastic leukemia (ALL). …