When Bone Lesions Scream For Leukemia-A Paradigmatic Case

A 34 months old male presented to the emergency department for reduced deambulation and left leg limping without a history of recent trauma or infection. Base laboratory evaluation, plain radiography and MRI of the femur and hip bone were inconclusive at first. For the worsening of the symptoms, a second plain radiography of the left femur detected a periosteal reaction of the distal third of the bone after 21 days. Thus, an orthopedic evaluation was performed at a tertiary orthopedic institution ten days later. Complete blood count revealed leukocytosis associated with thrombocytopenia, thus the patient was referred to our pediatric Oncology and Hematology Institution where the diagnosis of Acute Lymphoblastic Leukemia (ALL) was made. After starting chemotherapy the hip pain gradually resolved within the first week. At diagnosis, specific bone alterations such as juxta-metaphyseal bands in children with muscoloskeletric pain can precede blood test alterations, so the diagnosis of acute leukemia must be always ruled out.