{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T20:59:55Z","timestamp":1773176395030,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","license":[{"start":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T00:00:00Z","timestamp":1598313600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Colombo South Teaching Hospital"},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Reports in Hematology"],"published-print":{"date-parts":[[2020,8,25]]},"abstract":"<jats:p><jats:italic>Background<\/jats:italic>. Bone marrow necrosis (BMN) is a rare entity which presents with bone pain, fever, and peripheral cytopenia. Acute lymphoblastic leukaemia (ALL) is characterized by malignant proliferation of immature lymphocytes, and patients usually present with fatigue and bleeding manifestations. Presentation with BMN is an extremely rare finding and only few cases had been reported in the literature. <jats:italic>Case Presentation<\/jats:italic>. A 22-year-old male presented with nocturnal lower back ache, pleuritic central chest pain, and fever for two weeks. He was extensively investigated for a cause. His investigations revealed pancytopenia with severe neutropenia. Initial bone marrow aspiration and biopsy did not provide a positive result due to extensive necrosis. However, immunohistochemical analysis of few immature lymphoid cells on repeated BM biopsy showed evidence of acute lymphoblastic leukaemia. <jats:italic>Conclusions<\/jats:italic>. ALL usually presents with fatigue and bleeding manifestations. Presentation with BMN is extremely rare. The diagnosis was extremely challenging as this patient had only occasional atypical cells in the peripheral blood film and the repeat bone marrow (BM) biopsy showed extensive necrosis.<\/jats:p>","DOI":"10.1155\/2020\/8889850","type":"journal-article","created":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T23:33:04Z","timestamp":1598398384000},"page":"1-3","source":"Crossref","is-referenced-by-count":3,"title":["Extensive Bone Marrow Necrosis: A Rare Presentation of Acute Lymphoblastic Leukaemia"],"prefix":"10.1155","volume":"2020","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2188-5309","authenticated-orcid":true,"given":"I.","family":"Ranathunga","sequence":"first","affiliation":[{"name":"Professorial Medical Unit, Colombo South Teaching Hospital, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. R.","family":"Muthumala","sequence":"additional","affiliation":[{"name":"Department of Haematology, Faculty of Medicine, University of Sri Jayewardenepura, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. W. C. K.","family":"Kulathilake","sequence":"additional","affiliation":[{"name":"Department of Haematology, Faculty of Medicine, University of Sri Jayewardenepura, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Weerasinghe","sequence":"additional","affiliation":[{"name":"Cancer Institute, Maharagama, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. L. A.","family":"Shyamali","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, University of Sri Jayewardenepura, Colombo, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.10114"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(76)90752-x"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.139.8.905"},{"key":"4","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1002\/(SICI)1097-0142(20000415)88:8<1769::AID-CNCR3>3.0.CO;2-H","volume":"88","year":"2000","journal-title":"Cancer"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-62-4-698"},{"key":"6","year":"2010"},{"key":"7","year":"2008"},{"key":"8","year":"2010"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24074"},{"key":"10","first-page":"109","volume":"18","year":"1998","journal-title":"Annals of Clinical & Laboratory Science"},{"issue":"5","key":"11","first-page":"754","volume":"67","year":"1982","journal-title":"Haematologica"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.2830290408"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.05.0656"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.5144\/0256-4947.1997.374"}],"container-title":["Case Reports in Hematology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/crihem\/2020\/8889850.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crihem\/2020\/8889850.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crihem\/2020\/8889850.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T23:33:07Z","timestamp":1598398387000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/crihem\/2020\/8889850\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,25]]},"references-count":14,"alternative-id":["8889850","8889850"],"URL":"https:\/\/doi.org\/10.1155\/2020\/8889850","relation":{},"ISSN":["2090-6560","2090-6579"],"issn-type":[{"value":"2090-6560","type":"print"},{"value":"2090-6579","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,25]]}}}