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急性淋巴细胞白血病误为幼年特发性关节炎一例

孙 玄静, 张秀 胜*

摘要

儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)是儿科常见的血液系统肿瘤,占<15岁的儿童期癌症的30%[1],其特点为造血组织中幼稚淋巴细胞过度增生与分化成熟障碍,浸润到各组织和器官,典型的临床表现为发热、面色苍白、疲劳、淋巴结肿大、肝脾肿大、瘀斑瘀点等[2],有典型临床表现的ALL诊断并不困难,而少数患儿首发症状不典型甚至无血液系统表现,则不易诊断[3]。文献报道,15%-30%的ALL患者伴有肌肉骨骼系统的症状[4],在有关节受累的儿童中,很少出现白血病的临床表现和实验室体征,因此,诊断延迟是未发生关节受累的儿童的两倍[5]。以骨关节疼痛为首发症状的儿童ALL,早期易被误诊为幼年特发性关节炎(Juvenile idiopathic arthritis,JIA)或其他风湿系统疾病,本文报道1例以多关节肿痛起病,期间曾被误诊为 JIA 而予相关治疗,最终被确诊为 ALL的病例,旨在加深临床医师对以多关节肿痛为首发症状的儿童 ALL的认识,从而减少误诊漏诊。

关键词

急性淋巴细胞白血病;幼年特发性关节炎;误诊漏诊

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参考

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