SHM Converge Scientific Abstract ePoster Gallery-When Joint Pain Signals More: Beyond the Wrist

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A 7-year-old girl with a history of AML status post bone marrow transplant and remission presented with 3 days of bilateral knee pain and 1 day of left wrist pain. She had no fever or infectious symptoms. Exam showed mild left wrist swelling, tenderness, and decreased range of motion; the knees were normal.<br /><br />Initial labs were largely unremarkable except for an elevated LDH (464 U/L), with normal WBC, hemoglobin, platelets, uric acid, CRP, ESR, and procalcitonin. Wrist X-ray showed focal demineralization of the distal ulnar metaphyseal cortex. MRI of the left forearm/wrist revealed multifocal marrow lesions with T1 hypointensity, T2/STIR hyperintensity, and enhancement in the ulna and radius, plus similar abnormality in the left iliac crest—findings concerning for marrow infiltration.<br /><br />Because the leading differential included reactive arthritis, septic arthritis, and osteomyelitis, the patient was initially admitted and evaluated by orthopedics and oncology. A bone marrow biopsy on day 2 showed blasts on aspirate smear with normocellular marrow, confirming relapsed AML. She was transferred to the oncology service, a central line was placed, and chemotherapy was started.<br /><br />The case highlights that musculoskeletal pain can be the presenting symptom of AML in children and may mimic more common infectious or inflammatory conditions. Although late relapse after allogeneic stem cell transplant is uncommon, it must remain on the differential, especially when MSK pain is accompanied by elevated LDH or suspicious imaging.

Asset Subtitle

Olivia-Marie L. Groves

Meta Tag

Author List Olivia-Marie L. Groves, Sharon S. Clark

Category Clinical Vignettes

Concept Acute Myeloid Leukemia

Concept Leukemia Relapse

Concept Musculoskeletal pain

Concept Pediatric Joint Pain

Concept Bone Involvement

Distinguished Finalist

Presenter Organization Nationwide Children's Hospital

Presenting Author Olivia-Marie L. Groves

Track Pediatric

Keywords

acute myeloid leukemia

pediatric relapse

bone marrow transplant

musculoskeletal pain

wrist pain

marrow infiltration

elevated LDH

MRI lesions

bone marrow biopsy

allogeneic stem cell transplant

Acute Myeloid Leukemia

Leukemia Relapse

Musculoskeletal pain

Pediatric Joint Pain

Bone Involvement