Bone pain underlying leukaemia

Key words: Childhood leukaemia, Musculoskeletal manifestations, Differential diagnosis, Review

Acute Lymphoblastic Leukaemia (ALL) is the most common cancer disease in paediatric age. Even though in the last decade there has been a steady improve of the chances of survival from this disease, it is relatively uncommon in the life of a general paediatrician and still currently causes 30% of deaths by cancer in paediatric age. Diagnosis is sometimes delayed because of a scarce knowledge of the early or unusual signs underlying ALL onset. Through the analysis of three different cases, this article aims to refresh the models of presentation of this disease by focusing on the musculoskeletal and articular signs and symptoms. ALL should always be considered in children with musculoskeletal symptoms, especially when the clinical pattern is not characteristic of a specific rheumatic disease. Routine laboratory tests may be misleading. The simultaneous presence of high LDH and raised ESR or CRP, even with normal blood cell counts, should lead to additional investigations.