SHM Converge Scientific Abstract ePoster Gallery-An Adolescent With Migratory Arthralgia, Rash, and Proteinuria: A Rare Presentation of B-Lymphoblastic Lymphoma

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This case describes a 17-year-old boy with a recent Bell’s palsy who developed two months of migratory arthralgia, a pruritic nodular rash, abdominal pain, diarrhea, night sweats, inflammatory markers, and transient proteinuria. Exam showed non-blanching nodular skin lesions on the chest, back, and beard area, plus arthritis in several finger joints and right knee discomfort.<br /><br />Initial laboratory workup showed elevated CRP and ESR, with proteinuria but otherwise normal CBC and CMP. Extensive autoimmune and infectious testing was negative, including ANA, dsDNA, complements, ANCA, Lyme, tuberculosis, coccidioidomycosis, HIV, hepatitis, and sexually transmitted infections. Stool PCR was positive for enteroaggregative and enteropathogenic E. coli and Giardia, and he was treated for Giardia. After treatment, his joint symptoms, inflammatory markers, and proteinuria resolved, leading clinicians to suspect post-infectious/reactive arthritis.<br /><br />However, later skin biopsies revealed B-lymphoblastic lymphoma (B-LBL). On readmission, CT and PET imaging demonstrated widespread disease, including multiple nodular and plaque-like skin lesions, extensive bilateral renal involvement, and skeletal lesions.<br /><br />The report emphasizes that B-LBL is a rare non-Hodgkin lymphoma that can present with extranodal disease, especially involving the skin. In this patient, the combination of migratory arthritis, rash, and transient proteinuria, along with concurrent gastroenteritis and a strong family history of autoimmune disease, masked the underlying malignancy. The key clinical lesson is that adolescents with unexplained nodular rash and arthralgias, especially when autoimmune and infectious studies are unrevealing, should be evaluated for malignancy early, and skin biopsy should not be delayed.

Asset Subtitle

Heriberto Martinez

Meta Tag

Author List Heriberto Martinez, Lindsay Podraza, Nina Gupta, Richard Engel

Category Clinical Vignettes

Concept B-lymphoblastic lymphoma

Concept Skin involvement

Concept Biopsy

Concept Tissue Diagnosis

Concept Nodular rash

Distinguished Non-Finalist

Presenter Organization Phoenix Children's Hospital

Presenting Author Heriberto Martinez

Track Pediatric

Keywords

B-lymphoblastic lymphoma

adolescent

migratory arthralgia

nodular rash

proteinuria

reactive arthritis

skin biopsy

extranodal disease

renal involvement

gastroenteritis

B-lymphoblastic lymphoma

Skin involvement

Biopsy

Tissue Diagnosis

Nodular rash