Pediatrics & Neonatology
Volume 50, Issue 1 , Pages 33-35, February 2009

Salmonella Septic Arthritis Involving Multiple Joints in a Girl with Acute Lymphoblastic Leukemia at Diagnosis

  • Wei-Chin Yang

      Affiliations

    • Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
    • ,
  • Yhu-Chering Huang

      Affiliations

    • Division of Infectious Diseases, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
    • ,
  • Ming-Horng Tsai

      Affiliations

    • Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
    • ,
  • Cheng-Hsun Chiu

      Affiliations

    • Division of Infectious Diseases, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
    • ,
  • Tang-Her Jaing

      Affiliations

    • Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
    • Corresponding Author InformationCorresponding author. Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, 5 Fu-Shin Street, Kwei-Shan 333, Taoyuan, Taiwan

Received 14 February 2008; received in revised form 25 August 2008; accepted 1 December 2008.

Article Outline

Septic arthritis due to Salmonella has been reported frequently, but multiple joint involvements have rarely been reported in children. A 3-year-old girl presented with Salmonella arthritis involving multiple joints. Laboratory investigations revealed pancytopenia inconsistent with diagnosis of juvenile rheumatoid arthritis or septic arthritis. Bone marrow examination 2 weeks later confirmed the diagnosis of acute lymphoblastic leukemia (ALL). Immunophenotyping studies were consistent with a diagnosis of pre-B ALL. This case illustrates that a delay in the diagnosis may occur when there is an apparent infection focus without classic features of leukemia. Multiple joints involvement of septic arthritis associated with pancytopenia should highlight the possibility of underlying hematologic disorders.

Key Words:  acute lymphoblastic , leukemia , bone marrow , examination; , Salmonella , septic arthritis

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Friedmann AM , Weinstein HJ . The role of prognostic features in the treatment of childhood acute lymphoblastic leukemia . Oncologist . 2000;5:321–328
  2. Kumar R , Walsh A , Khalilullah K , McCormack D , Ryan S . An unusual orthopaedic presentation of acute lymphoblastic leukemia . J Pediatr Orthop B . 2003;12:292–294
  3. Forgie SE , Robinson JL . Pediatric malignancies presenting as a possible infectious disease . BMC Infect Dis . 2007;7:44
  4. Zhao H , Zhang L , Zhu X , et al.   Transient pancytopenia preceding T lineage acute lymphoblastic leukemia . Acta Haematol . 2004;112:167–169
  5. Mc Gaughey I . Septic arthritis of the hip in children . Aust Fam Physician . 1997;26:158–160
  6. Hollingsworth P . Differential diagnosis and management of hip pain in childhood . Br J Rheumatol . 1995;34:78–82
  7. Salzbach R . Pediatric septic arthritis . AORN J . 1999;70:991–1002
  8. Gottlieb T , Atkins BL , Shaw DR . Soft tissue, bone and joint infections . Med J Aust . 2002;176:609–615
  9. Chiu S , Chiu CH , Lin TY . Salmonella enterica serotype Choleraesuis infection in a medical center in northern Taiwan . J Microbiol Immunol Infect . 2004;37:99–102
  10. Huang JL , Hung JJ , Wu KC , Lee WI , Chan CK , Ou LS . Septic arthritis in patients with systemic lupus erythematosus: salmonella and nonsalmonella infections compared . Semin Arthritis Rheum . 2006;36:61–67

PII: S1875-9572(09)60027-9

doi:10.1016/S1875-9572(09)60027-9

Pediatrics & Neonatology
Volume 50, Issue 1 , Pages 33-35, February 2009

Article Tools