An Unusual Case of Acute Lymphoblastic Leukemia Presenting As Multiple Bone Infarcts

1Stony Brook University Medical Center, Stony Brook, NY

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 398

Case Presentation:

A 27‐year‐old African American man with a history of scoliosis status post spinal surgery as a child presented to our institution for evaluation of bone pain that began approximately 4 months prior to presentation. The patient reported having pain that started in his knees and then gradually progressed to his bilateral thighs, hips, and lower back. He described the pain as constant, dull, and exacerbated with weight bearing. In addition, the patient also developed fevers, night sweats, and weight loss approximately 1 month prior to presentation. At our institution, the patient underwent an extensive workup revealing the presence of sickle cell trait, an erythrocyte sedimentation rate of 122, a C‐reactive protein of 32, evidence for chronic disease anemia, a persistently high lactate dehydrogenase level, normal white blood cell count, mild thrombocytosis, and persistently negative blood cultures. Imaging included a whole‐body bone scan that was indeterminate for osteomyelitis of the thoracolumbar spine but revealed multiple bone infarcts and marrow expansion in the skull, sternum, sacroiliac, and pubic bones and bilateral femurs. Subsequently, a MRI of the pelvis was done that confirmed the finding of multiple bony infarcts and therefore osteomyelitis was considered less likely. Ultimately the patient underwent 2 consecutive bone marrow biopsies, the first of which revealed diffuse necrosis interspersed with relatively normal marrow elements that demonstrated no significant abnormalities on flow cytometry. The bone marrow core specimen taken during a second aspiration 1 day later, however, demonstrated a large amount of cellular debris, markedly reduced myeloid cells, and the presence of a population of cells (14% of total) that expressed CD19, CD20, CD34, TdT, and high‐intensity CD10 (calla), all of which were consistent with the diagnosis of acute leukemia of precursor B‐cell origin. The patient was then transferred to the leukemia service for chemotherapy.

Discussion:

Acute lymphoblastic leukemia (ALL) has an overall incidence of 1– 1.5 per 100,000 persons and a bimodal distribution: an early peak at approximately age 4–5 years, with an incidence as high as 4–5 per 100,000 persons, followed by a second gradual increase at about age 50 years, with an incidence of 2 per 100,000 persons. ALL is relatively rare during later childhood and young adulthood.

Conclusions:

We report this case to emphasize the unusual clinical presentation of this relatively treatable disease.

Disclosures:

A. Singh ‐ none; N. Trenard ‐ none; R. Reilly ‐ none

To cite this abstract:

Singh A, Trenard N, Reilly R. An Unusual Case of Acute Lymphoblastic Leukemia Presenting As Multiple Bone Infarcts. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 398. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/an-unusual-case-of-acute-lymphoblastic-leukemia-presenting-as-multiple-bone-infarcts/. Accessed May 26, 2019.

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