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• W1761045148 abstract "24 May 2011 Dear Editor, We thank McKay et al. for revealing findings at presentation predicting a diagnosis of acute lymphoblastic leukaemia (ALL) in a child presenting with features consistent with juvenile rheumatoid arthritis (JRA).1 Diagnosis of JRA is made by excluding other potential aetiologies of arthropathy, including malignancies. There is no single test to diagnose JRA, and the disease is determined by physicians clinically. Acute lymphoblastic leukaemia is the most common malignancy seen in childhood, and 15–30% of ALL patients may present with osteoarthritic manifestations.2 There is always a concern in physicians diagnosing patients with JRA that ALL is misdiagnosed. We report a T-cell lymphoma case initially diagnosed as JRA and treated with steroids and cytotoxic agents causing tumour lysis syndrome. The literature on children with lymphoma presenting as JRA is scarce, and this case emphasises the importance of excluding malignancies other than ALL in these patients. A 5-year-old boy was admitted because of cough, fever, arthralgia and bone pain. He was first evaluated at another centre 3 weeks ago, and a bone marrow aspiration performed was normal. He was diagnosed as JRA, and methylprednisolone and methotrexate treatments were initiated. Physical examination showed diffuse lymphadenopathies and a swollen right knee. Blood count revealed only leucocytosis; blood chemistry was consistent with tumour lysis syndrome and a chest X-ray showed mediastinal mass with pleural effusion. Bone marrow aspiration showed 20% blasts; immunophenotype was consistent with T cell leukaemia/lymphoma. The boy is treated according to Berlin-Frankfurt-Munster-95 ALL protocol. Children with malignancies other than leukaemia may also present with rheumatological manifestations; however, there is scarce data on rheumatological presentations of other malignancies. A retrospective review of 29 children who were referred to paediatric rheumatology centres showed a final diagnosis of leukaemia, neuroblastoma, lymphoma, Ewing's sarcoma, ependymoma, thalamic glioma, epithelioma and sarcoma.3 A high index of suspicion is needed in patients diagnosed as JRA, and further studies such chest x-ray and abdominal ultrasonography may be warranted in suspected cases. Pain localised to bone more than joint, night-time pain, significant weight loss and night sweats, bruising, back pain, abnormal blood count and elevated lactate dehydrogenase level should alert the physician.1 In conclusion, children with musculoskelatal complaints should be carefully evaluated before a diagnosis of JRA is made. An oncologist may be involved in the management of these patients especially in children with atypical features. An early blood count and even bone marrow aspiration is not comforting enough to exclude malignancy." @default.
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• W1761045148 date "2012-04-01" @default.
• W1761045148 modified "2023-10-17" @default.
• W1761045148 title "T-CELL LYMPHOMA MASQUERADING AS JUVENILE RHEUMATOID ARTHRITIS" @default.
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• W1761045148 doi "https://doi.org/10.1111/j.1440-1754.2012.02437.x" @default.
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