A 5-year-old girl is transferred to your facility for evaluation of severe lumbar pain. The child was in her usual state of health until about three weeks ago, when she developed acute back pain. She does not have any specific history of injury or trauma. There is a history of associated intermittent fevers and occasional nausea.
Upon examination, you note an ill-appearing child. Vital signs are stable. She has generalized tenderness throughout her spinal column. Her pain is such that she is unable to ambulate because of it. Review of her lab work shows her hemoglobin level to be 6.2 g/dL. Radiograph of the lumbar spine is obtained (shown).
Answer
The radiograph demonstrates global loss of vertebral body height, most pronounced at L3 and L4. In addition, there is generalized osteopenia throughout the vertebral column.
Such findings in this age-group can be attributed to metabolic or congenital bone diseases. Eosinophilic granuloma or metastatic disease is another possibility. This patient underwent bone marrow biopsy, which confirmed the diagnosis of acute lymphoblastic leukemia.
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