Back pain as a first symptom of hematologic malignancy in a 9-year-old girl

Abstract Described case involves 9-year-old, otherwise healthy girl, which was admitted to a local hospital due to acute back pain persisting for a couple of days. Pain appeared suddenly, without any preceding trauma, and was accompanied by fever. Physical examination was normal apart from forced, defensive back flexion. Initial laboratory tests showed elevated inflammatory markers without any additional changes in blood cell count. Patient was transferred to Rheumatology Department of Children's Clinical Hospital in Lublin, Poland for further diagnosis and treatment. Extensive diagnostic procedures were performed, including bone scan, MRI of the spinal column and multiple laboratory tests. Pain and fever persisted despite intensive anti-inflammatory and antibiotic therapy. Changes in blood morphology led to extended oncological diagnostics. Eventually patient was diagnosed as having acute lymphoblastic leukemia (pre-B ALL).