Abstract
Background: Low back pain is a common symptom in the pediatric population; approximately half of all children present with at least one episode of low back pain. The majority of cases are due to nonspecific causes such as musculoskeletal trauma with spontaneous regression. On some occasions, however, life-threatening diseases have to be considered. Case Report: A 15-year-old girl presented to the Pediatric Emergency Department for a history of continuous 2-day duration of low back pain and transient paresthesia of the right gluteal area. Low back pain was diagnosed and nonsteroidal anti-inflammatory treatment combined with rest were prescribed. After 7 days, worsening of the clinical conditions was observed with bilateral gluteus paresthesia. A corset was recommended, and magnetic resonance imaging (MRI) and rheumatological evaluation were prescribed on an outpatient basis. After 5 days she was hospitalized due to urinary incontinence and persistence of pain. Blood tests revealed neutrophil leukocytosis associated with mild anemia, thrombocytopenia, hyperuricemia, and increased lactate dehydrogenase. MRI examination of the spine demonstrated a mass involving the sacral canal and the presacral region, extending through the sacral foramina, along the nerve roots. Similar tissue was found at multiple levels in the spine and in the right orbit. Bone marrow aspiration and biopsy highlighted the presence of myeloid blasts and myeloid dysplasia, consequently, myeloid sarcoma was diagnosed. Why Should an Emergency Physician Be Aware of This?: Our case demonstrates the importance of prompt identification of diagnostic "red flags" in childhood low back pain, indicating the need for diagnostic investigations such as MRI and blood tests.
| Original language | English |
|---|---|
| Journal | Journal of Emergency Medicine |
| DOIs | |
| Publication status | Accepted/In press - Apr 5 2015 |
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Keywords
- Children
- Low back pain
- Myeloid sarcoma
- Pediatrics
ASJC Scopus subject areas
- Emergency Medicine
Cite this
Myeloid Sarcoma Presenting as Low Back Pain in the Pediatric Emergency Department. / Massoud, Michela; Del Bufalo, Francesca; Caterina Musolino, Anna Maria; Schingo, Paolo Maria; Gaspari, Stefania; Pisani, Mara; Orazi, Cinzia; Reale, Antonino; Raucci, Umberto.
In: Journal of Emergency Medicine, 05.04.2015.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Myeloid Sarcoma Presenting as Low Back Pain in the Pediatric Emergency Department
AU - Massoud, Michela
AU - Del Bufalo, Francesca
AU - Caterina Musolino, Anna Maria
AU - Schingo, Paolo Maria
AU - Gaspari, Stefania
AU - Pisani, Mara
AU - Orazi, Cinzia
AU - Reale, Antonino
AU - Raucci, Umberto
PY - 2015/4/5
Y1 - 2015/4/5
N2 - Background: Low back pain is a common symptom in the pediatric population; approximately half of all children present with at least one episode of low back pain. The majority of cases are due to nonspecific causes such as musculoskeletal trauma with spontaneous regression. On some occasions, however, life-threatening diseases have to be considered. Case Report: A 15-year-old girl presented to the Pediatric Emergency Department for a history of continuous 2-day duration of low back pain and transient paresthesia of the right gluteal area. Low back pain was diagnosed and nonsteroidal anti-inflammatory treatment combined with rest were prescribed. After 7 days, worsening of the clinical conditions was observed with bilateral gluteus paresthesia. A corset was recommended, and magnetic resonance imaging (MRI) and rheumatological evaluation were prescribed on an outpatient basis. After 5 days she was hospitalized due to urinary incontinence and persistence of pain. Blood tests revealed neutrophil leukocytosis associated with mild anemia, thrombocytopenia, hyperuricemia, and increased lactate dehydrogenase. MRI examination of the spine demonstrated a mass involving the sacral canal and the presacral region, extending through the sacral foramina, along the nerve roots. Similar tissue was found at multiple levels in the spine and in the right orbit. Bone marrow aspiration and biopsy highlighted the presence of myeloid blasts and myeloid dysplasia, consequently, myeloid sarcoma was diagnosed. Why Should an Emergency Physician Be Aware of This?: Our case demonstrates the importance of prompt identification of diagnostic "red flags" in childhood low back pain, indicating the need for diagnostic investigations such as MRI and blood tests.
AB - Background: Low back pain is a common symptom in the pediatric population; approximately half of all children present with at least one episode of low back pain. The majority of cases are due to nonspecific causes such as musculoskeletal trauma with spontaneous regression. On some occasions, however, life-threatening diseases have to be considered. Case Report: A 15-year-old girl presented to the Pediatric Emergency Department for a history of continuous 2-day duration of low back pain and transient paresthesia of the right gluteal area. Low back pain was diagnosed and nonsteroidal anti-inflammatory treatment combined with rest were prescribed. After 7 days, worsening of the clinical conditions was observed with bilateral gluteus paresthesia. A corset was recommended, and magnetic resonance imaging (MRI) and rheumatological evaluation were prescribed on an outpatient basis. After 5 days she was hospitalized due to urinary incontinence and persistence of pain. Blood tests revealed neutrophil leukocytosis associated with mild anemia, thrombocytopenia, hyperuricemia, and increased lactate dehydrogenase. MRI examination of the spine demonstrated a mass involving the sacral canal and the presacral region, extending through the sacral foramina, along the nerve roots. Similar tissue was found at multiple levels in the spine and in the right orbit. Bone marrow aspiration and biopsy highlighted the presence of myeloid blasts and myeloid dysplasia, consequently, myeloid sarcoma was diagnosed. Why Should an Emergency Physician Be Aware of This?: Our case demonstrates the importance of prompt identification of diagnostic "red flags" in childhood low back pain, indicating the need for diagnostic investigations such as MRI and blood tests.
KW - Children
KW - Low back pain
KW - Myeloid sarcoma
KW - Pediatrics
UR - http://www.scopus.com/inward/record.url?scp=84979649738&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84979649738&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2016.01.033
DO - 10.1016/j.jemermed.2016.01.033
M3 - Article
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
SN - 0736-4679
ER -