Adult acute lymphoblastic leukaemia with lytic bone lesions

Abstract

A 52-year-old horse agister presented with 3-month history of fevers, night sweats, 10 kg weight loss, myalgia and backache. He was found initially to have a suspicious bony lesion on plain radiograph of his pelvis, but a bone scan showed no abnormal focal uptake. Computed tomography (CT) scans showedlyticdestructivelesionsatC6andanirregularlucency of the T3 vertebra ( Fig. 1). A CT-guided biopsy showed an immature mononuclear infiltration suspicious of haematological malignancy (Fig. 2). Baseline blood tests showed that 6% lymphoblasts on peripheral blood with white cell count 4.05 Â 10 9 /L, haemoglobin 128 g/L and platelets 49 Â 10 9 / L. Serum-corrected calcium was increased at 2.72 mmol/L (2.10-2.55 mmol/L). Bone marrow examination confirmed the diagnosis of acute lymphoblastic leukaemia (Fig. 3). Magnetic resonance imaging of the spine carried out while the patient was receiving chemotherapy showed compression fractures at C6 and T3 (Fig. 4).Lytic lesions as a presentation of acute lymphoblastic leukaemia (ALL) have been described previously, particularly in the paediatric population, 1 but only rarely in adult ALL. 2 Figure 1 CT scan demonstrating destructive lesion C6 on left and irregular lucency on right at T3 vertebra.