Vertebral Compression Fractures as a Presenting Feature of AcuteLymphoblastic Leukemia

Aparna Das,Farnaz Nobi,Gobinda Banik,Md Azizul Kahhar

doi:10.3329/jom.v17i2.30078

Abstract

Acute lymphoblastic leukemia is one of the most common malignancies in children and adolescent accounting for 30% of all the cancers. We report an interesting case of Acute lymphoblastic leukaemia(ALL) with an unusual presentation.This 15year- old girl came with a progressive low back pain for three months following a history of fall for 5 month ago with intact consciousness. The physical examination showed gibbus over lumbar spine with tenderness. Images showed generalized osteopenia with multiple vertebral body collapse.Complete blood count revealed pancytopenia with raised ESRwithout any blast cell. Bone marrow aspirate was suggestive of ALL.Young ALL patients usually present with symptoms due to cytopenias, fever and bone pains. Although asymptomatic skeletal involvement may be present in patients with ALL, rarely patients present with pathological fractures. Therefore a high index of suspicion is needed to diagnose such case.J MEDICINE July 2016; 17 (2) : 120-121

Highlights

Bone and joint pain may be presenting symptoms in 25% patients in acute leukemia1whereasgeneralized osteopeniaand vertebral complications are less common[2]
Children usually present with symptoms due to cytopenias,organomegaly, lymphadenopathy and bone pains.Children and adolescent with leukemia may initially present to the rheumatologist with leukemic arthritis.[3]
There are very few reports of childhood ALL presenting with severe osteopenia.We report an interesting case of a 15 year old girl who presented with severe low back pain and vertebral compression

Summary

Introduction

Bone and joint pain may be presenting symptoms in 25% patients in acute leukemia1whereasgeneralized osteopeniaand vertebral complications are less common[2]. For the last two months pain was so severe that patient refused to move orwalk.She had intermittent fever, generalized weakness and weight loss for last 2 months. Her motor and mental development was normal for age.There was no significant past and family history. USG of whole abdomen revealed: Splenomegaly with prominent intraabdominal lymphnodes

Discussion

Findings

Conclusion