Extensive Bone Marrow Necrosis: A Rare Presentation of Acute Lymphoblastic Leukaemia.

I Ranathunga,S Weerasinghe,N L A Shyamali,N R Muthumala,H W C K Kulathilake

doi:10.1155/2020/8889850

Abstract

Background Bone marrow necrosis (BMN) is a rare entity which presents with bone pain, fever, and peripheral cytopenia. Acute lymphoblastic leukaemia (ALL) is characterized by malignant proliferation of immature lymphocytes, and patients usually present with fatigue and bleeding manifestations. Presentation with BMN is an extremely rare finding and only few cases had been reported in the literature. Case Presentation. A 22-year-old male presented with nocturnal lower back ache, pleuritic central chest pain, and fever for two weeks. He was extensively investigated for a cause. His investigations revealed pancytopenia with severe neutropenia. Initial bone marrow aspiration and biopsy did not provide a positive result due to extensive necrosis. However, immunohistochemical analysis of few immature lymphoid cells on repeated BM biopsy showed evidence of acute lymphoblastic leukaemia. Conclusions ALL usually presents with fatigue and bleeding manifestations. Presentation with BMN is extremely rare. The diagnosis was extremely challenging as this patient had only occasional atypical cells in the peripheral blood film and the repeat bone marrow (BM) biopsy showed extensive necrosis.

Highlights

Bone marrow necrosis (BMN) is a rare entity which presents with bone pain, fever, and peripheral cytopenia
Antineoplastic drugs, and granulocyte colony-stimulating factors are some of the causative drugs [1]. e pathophysiology of bone marrow (BM) necrosis can be due to several processes and mainly involves failure of the microcirculation [6]
Our patient presented with bicytopenia and a leucoerythroblastic blood picture which can be a common presentation of hematological malignancies. e diagnosis of BMN is pathognomically made on the basis of bone marrow aspiration and biopsy findings

Summary

Background

Bone marrow necrosis (BMN) is characterized by necrosis of the medullary stroma and myeloid tissues of the haematopoietic bone marrow (BM), leaving an amorphous eosinophilic background, necrotic cells, and preserved cortical bone [1]. It is a rare disorder with only few reported cases in the literature. Severity is graded as severe, moderate, and mild according to the percentage of the diameter of the biopsy showing necrosis [1]. Few cases of ALL have been reported as presenting with extensive bone marrow necrosis in the literature [1]

Case Presentation

Discussion and Conclusions