以单骨痛为首发症状的儿童急性白血病误诊原因分析  

Analysis of Causes of Misdiagnosis of Acute Leukemia in Children with Single Bone Pain as the Initial Symptom

作　　者：李论 杨佳 徐涛涛 周平[1] LI Lun;YANG Jia;XU Taotao;ZHOU Ping(Department of Orthopaedics,Kunming Children's Hospital,Kunming 650000,China)

机构地区：[1]昆明市儿童医院骨科,昆明650000

出　　处：《临床误诊误治》2024年第3期26-28,共3页Clinical Misdiagnosis & Mistherapy

基　　金：昆明市卫生健康委员会卫生科研课题项目(2022-04-07-004)。

摘　　要：目的 探讨以单骨痛为首发症状的儿童急性白血病的误诊原因及防范措施。方法 回顾性分析2019年1月—2022年12月收治的初诊误诊为骨髓炎的急性白血病患儿2例的临床资料。结果 2例初诊时均因患侧肢体疼痛就诊,均为下肢,伴有发热症状,行血常规检查示白细胞计数均正常,2例C反应蛋白增高,行X线及MRI检查后,1例误诊为胫骨急性骨髓炎,1例误诊为股骨急性骨髓炎。2例均行手术治疗,术中未见明显骨膜或骨髓腔内脓肿,术后病理检查确诊为急性淋巴细胞白血病;2例均转血液科继续治疗,1例治疗后缓解,1例尚在抗肿瘤治疗中。结论 以单骨痛为首发症状的儿童急性白血病缺乏特异性临床表现,影像学检查难以与骨感染性疾病鉴别,容易导致治疗方案不当,掌握该病的临床特点,必要时行骨髓穿刺检查,是减少或避免误诊误治的关键。Objective To explore the causes of misdiagnosis and preventive measures of acute leukemia(AL) in children with single bone pain as the initial symptom.Methods The clinical data of two children with AL misdiagnosed as osteomyelitis at initial visit and admitted to our hospital from January 2019 to December 2022 were retrospectively analyzed.Results At the initial diagnosis,all 2 patients presented with pain in the affected side of the lower limb,accompanied by fever.Routine blood tests showed normal white blood cell counts,and 2 patients showed increased C reactive protein.After X-ray and MRI examinations,1 patient was misdiagnosed as acute tibia osteomyelitis,and 1 patient was misdiagnosed as acute femur osteomyelitis.The two patients were treated by operation,no obvious periosteal or intramedullary abscess was found during operation,and acute lymphoblastic leukemia was confirmed by postoperative pathological examination.Two patients were transferred to Department of Hematology for subsequent treatment,1 patient was in remission after treatment,and 1 patient was still receiving anti-tumor therapy.Conclusion AL in children with single bone pain as the initial symptom lacks specific clinical manifestations,and it is difficult to distinguish from bone and joint infectious diseases by imaging examination,which may lead to inappropriate treatment regimen.Understanding the clinical characteristics of the disease and performing bone marrow puncture examination when necessary are the key to reducing or avoiding misdiagnosis and mistreatment.

关 键 词：急性白血病 误诊 骨髓炎 单骨痛 C反应蛋白 病理学 分子 骨髓检查 儿童 

分 类 号：R733.7[医药卫生—肿瘤]