Bone and joint disease – Not always a rheumatological diagnosis

Abstract

Abstract A 17-year-old female presented with a 7-day history of joint pains involving the bilateral knee, ankle and small joints of the hands and feet symmetrically, associated with bilateral knee joint swelling and early morning stiffness and bilateral red eyes. General examination was normal except for pallor. Musculoskeletal system examination revealed bilateral swollen and tender knee joints with restriction of movement along with tenderness in the bilateral shoulder, elbow, ankle joints and spine from T3 to T7 thoracic vertebral levels. Examination of other systems was normal. Investigations showed anaemia, elevated urea and creatinine. Skeletal survey showed multiple lytic lesions. Positron emission tomography revealed multiple punched-out lytic lesions in skull bones, scapulae, sternum, clavicles, ribs on both sides, vertebrae at multiple levels and in pelvic girdle bones. Few lesions showed mild 18fluorodeoxyglucose (18FDG) uptake, metaphyseal moth-eaten lysis in long bones with mild FDG uptake. Bone marrow biopsy and immunohistochemistry confirmed the diagnosis of acute B-cell lymphoblastic leukaemia. The terminology is according to 2016 revision of WHO classification of myeloid neoplasms and acute leukemia.