{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T13:07:51Z","timestamp":1773148071122,"version":"3.50.1"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Leukemia is the most common childhood malignancy, and it is often characterized by pallor, fatigue, cytopenia, and organomegaly; sometimes musculoskeletal symptoms, mainly characterized by diffuse bone pain in the lower extremities, are the onset clinical characteristics of the disease. In these cases, the disease may initially be misdiagnosed as reactive arthritis, osteomyelitis, or juvenile idiopathic arthritis delaying appropriate diagnosis and management. Even if leukopenia, thrombocytopenia, and a history of nighttime pain are reported to be the most important predictive factors for a pediatric leukemia, blood examinations can sometimes be subtle or within normal limits, and this represents a further diagnostic difficulty. Radiological findings of leukemic bone involvement are described in patients with musculoskeletal symptoms of acute lymphoblastic leukemia and often appear before hematologic anomalies, but they are not specific for the disease. However, they could be helpful to get the right diagnosis if integrated with other features; thus, it is important knowing them, and it is mandatory for the multidisciplinary comparison to talk about dubious cases even in an emergency setting. We describe 4 patients visited in the emergency department for musculoskeletal complaints and having radiological lesions and a final diagnosis of acute lymphoblastic leukemia, in whom the onset of the manifestations could mimic orthopedic\/rheumatologic diseases.<\/jats:p>","DOI":"10.1097\/pec.0000000000001694","type":"journal-article","created":{"date-parts":[[2018,11,21]],"date-time":"2018-11-21T08:12:59Z","timestamp":1542787979000},"page":"e412-e416","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["Uncommon Presentation of Childhood Leukemia in Emergency Department"],"prefix":"10.1097","volume":"37","author":[{"given":"Elena","family":"Boccuzzi","sequence":"first","affiliation":[{"name":"Emergency Pediatric Department, Bambino Ges\u00f9 Children's Hospital, IRCCS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina A.","family":"Ferro","sequence":"additional","affiliation":[{"name":"Emergency Pediatric Department, Bambino Ges\u00f9 Children's Hospital, IRCCS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca","family":"Cinicola","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo M.","family":"Schingo","sequence":"additional","affiliation":[{"name":"Radiology"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luisa","family":"Strocchio","sequence":"additional","affiliation":[{"name":"Pediatric Hematology and Oncology, Bambino Ges\u00f9 Children's Hospital, IRCCS, Rome, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umberto","family":"Raucci","sequence":"additional","affiliation":[{"name":"Emergency Pediatric Department, Bambino Ges\u00f9 Children's Hospital, IRCCS"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2018,11,20]]},"reference":[{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1136\/archdischild-2014-307751","article-title":"Arthritis as presenting manifestation of acute lymphoblastic leukaemia in children","volume":"100","year":"2015","journal-title":"Arch Dis Child"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1200\/JCO.2009.27.0421","article-title":"Outcomes for children and adolescents with cancer: challenges for the twenty-first century","volume":"28","year":"2010","journal-title":"J Clin Oncol"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1002\/cncr.23169","article-title":"Trends in childhood cancer incidence in the U.S. (1992\u20132004)","volume":"112","year":"2008","journal-title":"Cancer"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s00296-009-1064-7","article-title":"Arthritic presentation of acute leukemia in children: experience from a tertiary care centre in North India","volume":"30","year":"2010","journal-title":"Rheumatol Int"},{"key":"bib8-20250504","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1056\/NEJMra1400972","article-title":"Acute lymphoblastic leukemia in children","volume":"373","year":"2015","journal-title":"N Engl J Med"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/BPB.0b013e32835d731c","article-title":"Musculoskeletal problems in pediatric acute leukemia","volume":"22","year":"2013","journal-title":"J Pediatr Orthop"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1002\/cncr.22849","article-title":"Diagnosis delays in childhood cancer","volume":"110","year":"2007","journal-title":"Cancer"},{"key":"bib11-20250504","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s11832-007-0013-9","article-title":"Acute lymphoblastic leukemia in children: correlation of musculoskeletal manifestations and immunophenotypes","volume":"1","year":"2007","journal-title":"J Child Orthop"},{"key":"bib12-20250504","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1136\/pgmj.67.788.562","article-title":"Arthritic presentation of childhood leukaemia","volume":"67","year":"1991","journal-title":"Postgrad Med J"},{"key":"bib13-20250504","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/S0022-3476(05)83543-7","article-title":"Differentiation of systemic juvenile rheumatoid arthritis from acute leukemia near the onset of disease","volume":"122","year":"1993","journal-title":"J Pediatr"},{"key":"bib14-20250504","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1542\/peds.2005-1515","article-title":"A multicenter case-control study on predictive factors distinguishing childhood leukemia from juvenile rheumatoid arthritis","volume":"117","year":"2006","journal-title":"Pediatrics"},{"key":"bib15-20250504","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1002\/mpo.2950110417","article-title":"Skeletal scintigraphy and radiograph at onset of acute lymphocytic leukaemia in children","volume":"11","year":"1983","journal-title":"Med Pediatr Oncol"},{"key":"bib16-20250504","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1007\/s00296-010-1584-1","article-title":"Arthritic presentation of childhood malignancy: beware of normal blood counts","volume":"31","year":"2011","journal-title":"Rheumatol Int"},{"key":"bib17-20250504","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1136\/archdischild-2016-311251","article-title":"Clinical presentation of childhood leukaemia: a systematic review and meta-analysis","volume":"101","year":"2016","journal-title":"Arch Dis Child"},{"key":"bib18-20250504","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S0022-3476(05)80535-9","article-title":"Bone pain as an initial symptom of childhood acute lymphoblastic leukemia: association with nearly normal hematologic indexes","volume":"117","year":"1990","journal-title":"J Pediatr"},{"key":"bib19-20250504","first-page":"460","article-title":"The musculo-skeletal manifestations of acute lymphatic leukaemia in childhood","volume":"8","year":"1984","journal-title":"Orthop Trans"},{"key":"bib20-20250504","doi-asserted-by":"crossref","first-page":"494","DOI":"10.2106\/00004623-198668040-00003","article-title":"Orthopaedic manifestations of leukemia in children","volume":"68","year":"1986","journal-title":"J Bone Joint Surg Am"},{"key":"bib21-20250504","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1007\/s10067-009-1221-0","article-title":"Predictive plain x-ray findings in distinguishing early stage acute lymphoblastic leukemia from juvenile idiopathic arthritis","volume":"28","year":"2009","journal-title":"Clin Rheumatol"},{"key":"bib22-20250504","doi-asserted-by":"crossref","first-page":"50","DOI":"10.5812\/iranjradiol.6765","article-title":"Bony lesions in pediatric acute leukemia: pictorial essay","volume":"9","year":"2012","journal-title":"Iran J Radiol"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000001694","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,4]],"date-time":"2025-05-04T18:08:27Z","timestamp":1746382107000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000001694"}},"subtitle":["The Usefulness of an Early Multidisciplinary Approach"],"short-title":[],"issued":{"date-parts":[[2018,11,20]]},"references-count":19,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000001694","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2018,11,20]]}}}