A 20-month-old Caucasian woman with no relevant family or perinatal history.
Three months before the beginning of the current process, she suffered an aphthous stoma accompanied by high fever and moderate affectation of the general state.
When she came to the clinic she had intermittent lameness of the left limb for two weeks.
The examination did not reveal any limitation to auscultation, passive mobility was normal, there was no evidence of joint block or inflammatory signs, and the patient was able to walk on the left side.
The patient had no fever and the rest of the examination was normal, without fever, lymphadenopathy or hepatomegaly.
Antibiotic treatment with ibuprofen was prescribed.
A week later, due to the persistence of symptoms, the patient was referred to the referral regional hospital, where an ultrasound of the hips showed no pathological findings, only some liquid inside the synovial capsule.
If hip synovitis (CS) is suspected, it is decided to continue treatment with antiarrhythmic drugs and follow-up with a new ultrasound scan of the hips, reported as normal.
Four weeks after the onset of symptoms, the discomfort described persists and night pains appear in the limbs.
The child does not locate the pain well but has intense crying at night.
During the day, parents observe frequent falls.
It is evaluated by a traumatologist who does not detect significant abnormalities.
Eosinophil count, platelet count abnormal, platelet count abnormal, platelet count abnormal
General biochemistry with transaminase, creatine phosphokinase and iron metabolism within normal parameters.
Once these values were established, it was decided to repeat the analytical test seven days later.
The study shows then persistence of neutropenia with neutrophil count of 490/μl and leukocytes of 5600/μl.
The serology of parvovirus B19 was negative.
Chest X-ray and abdominal ultrasound were normal.
The persistence of symptoms was performed a third analytical seven days later.
The results of this third analytical were: leukocytes 9400/μl, neutrophils 820/μl, and specific neuronal enolase: 31.08 ng/ml (0-16.3 ng/mlLDH) 500-480 IU).
With these results, the performance of a bone scintigraphy is evaluated, as well as consultation with the referral ontology service, which recommends referral of the case for study.
Finally, the girl was diagnosed with lymphocytic leukemia after spinal puncture.
Blasts were observed only in the bone marrow and not in peripheral blood.
