{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:10:01Z","timestamp":1756379401922,"version":"3.44.0"},"reference-count":8,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,3,28]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>A pre-schooler, born out of a non-consanguineous marriage, presented with on-and-off fever for 9 months, fleeting large joint swelling involving multiple joints for 5 months, weakness and pain in different limbs for 5 months, and difficulty in breathing for 2 weeks, 3 months ago. Initial differentials considered were haematogenous osteomyelitis and systemic-onset juvenile idiopathic arthritis. There was no rash, lymphadenopathy or hepatosplenomegaly. The initial bone marrow biopsy showed chronic inflammation and normal haematopoietic cells. The child developed septic arthritis in the right knee during hospitalisation. After excluding malignancy, chronic recurrent multifocal osteomyelitis was diagnosed, and anti-inflammatory medication was prescribed. Subsequently, the child exhibited pancytopenia and hepatosplenomegaly 2 months after hospital stay, and further bone marrow biopsy confirmed acute lymphoblastic leukaemia. This case underscores the importance of maintaining a vigilant approach to leukaemia when children present with musculoskeletal symptoms, as early detection and treatment are crucial for improving outcomes in childhood acute leukaemia.<\/jats:p>","DOI":"10.1136\/bcr-2024-264688","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T16:21:46Z","timestamp":1744042906000},"page":"e264688","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute lymphoblastic leukaemia presenting as chronic recurrent multifocal osteomyelitis"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7122-7216","authenticated-orcid":false,"given":"Devina","family":"Singh","sequence":"first","affiliation":[{"name":"Paediatrics, King George\u2019s Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arpita","family":"Bhriguvanshi","sequence":"additional","affiliation":[{"name":"Paediatrics, King George\u2019s Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chandra Kanta","family":"Kumar","sequence":"additional","affiliation":[{"name":"Paediatrics, King George\u2019s Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nishant","family":"Verma","sequence":"additional","affiliation":[{"name":"Paediatrics, King George\u2019s Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"2025082803364288000_18.4.e264688.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2354.2005.00513.x"},{"key":"2025082803364288000_18.4.e264688.2","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s12969-016-0109-1","article-title":"Chronic recurrent multifocal osteomyelitis (CRMO) \u2013 advancing the diagnosis","volume":"14","author":"Roderick","year":"2016","journal-title":"Pediatr Rheumatol"},{"key":"2025082803364288000_18.4.e264688.3","first-page":"3","article-title":"Musculoskeletal manifestations in children with acute lymphoblastic leukaemia","volume":"3","author":"Mulder","year":"2012","journal-title":"Belg J Hematol"},{"key":"2025082803364288000_18.4.e264688.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)33018-1"},{"key":"2025082803364288000_18.4.e264688.5","doi-asserted-by":"crossref","first-page":"171","DOI":"10.5606\/ehc.2015.35","article-title":"Elbow septic arthritis associated with pediatric acute leukemia: a case report and literature review","volume":"26","author":"Uemura","year":"2015","journal-title":"Eklem Hastalik Cerrahisi"},{"key":"2025082803364288000_18.4.e264688.6","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1007\/s00247-019-04510-5","article-title":"Imaging mimics of chronic recurrent multifocal osteomyelitis: avoiding pitfalls in a diagnosis of exclusion","volume":"50","author":"Sato","year":"2020","journal-title":"Pediatr Radiol"},{"key":"2025082803364288000_18.4.e264688.7","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1007\/BF02484425","article-title":"Chronic recurrent multifocal osteomyelitis after acute lymphoblastic leukaemia","volume":"18","author":"Abril","year":"1994","journal-title":"Int Orthop"},{"key":"2025082803364288000_18.4.e264688.8","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.1097\/MPH.0b013e3181d1ec16","article-title":"Chronic recurrent multifocal osteomyelitis as the first presentation of acute lymphoblastic leukemia in a 2-year-old boy","volume":"32","author":"Tavil","year":"2010","journal-title":"J Pediatr Hematol Oncol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-264688","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:36:48Z","timestamp":1756377408000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-264688"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":8,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,7]]},"published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1136\/bcr-2024-264688"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-264688","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,4]]}}}