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Forum Name: Rheumatology Topics

Question: 3yr old, intermittent knee pain, no swelling, & ALL


 ckmom - Wed May 06, 2009 2:55 pm

My daughter begain limping last spring. Complained of pain in her left leg for almost 2 months. Then began complaining of right knee pain. Bone scan revealed a VERY SMALL area that was biopsied. She was dx with ALL pre-b. Dx was made exclusively on femur biopsy from left leg. Hip biopsy was clean. She has been undergoing chemotherapy for almost a year now, yet the knee pain has not subsided. She still shows no swelling, warmth, or redness in her knees when she complains. Yet she wakes up in the middle of the night in agony. Ironically enough, we went back to the pediatric rheumatologist, who said he had never encounted anything like this before. Our oncologist thinks she may have some autoimmune/rheumatoid condition. She had a positive ANA last year & dx of Sjoegrens before the ALL diagnosis. They have retested her for autoimmune, but most of the tests don't reveal anything or have not come back yet. Her bloodwork at dx was unremarkable-everything was within normal ranges except her ESR and CRP were extremely elevated. Her last ESR was 28 (again she is only 3). Our docs are all baffled, and figure they will have to wait until she is off chemotherapy to continue searching for the cause of the knee pain.
Now that the background is done...my question is whether there is anything that could cause the knee pain and not actually cause swelling. She has a few weird things happen lately as well, her fingers turning blue several times to mention one.
She suffered from hives and swollen lymph glands in her neck for a year before any other diagnosis. And always took a really long time (months) to heal from bug bites. And has always bruised easily. I'm not sure what would be relavent at this point, I'm just looking for suggestions as to why the original symptom after a year of treatment? Also, she has muscle weakness and delayed gross motor skills (assessed 18 months behind her age). She is very stiff when she gets up in the morning, and her muscles fatigue (in her legs) after working out (like phyiscal therapy or playing) even though she is not really tired herself.
Any insight would be appreciated. I'm not looking for anything exact I suppose, just some insight into another possibility for her chronic "flares" of knee pain.
 Tom Plamondon PA-C - Sun May 17, 2009 9:59 pm

User avatar Hello,
Thanks for writing in.

The nocturnal pain and swollen lymph nodes are reminiscent of leukemia.

Knee joint pain in a three year old who has been diagnosed with leukemia, has elevated CRP and sed rates, and a positive ANA - one does wonder about concomittant rheumatological disease.

I agree that you should wait until after the chemo to sift through the symptoms and lab work to judge about the cause of the knee pain.

I am curious about any x-ray done and physical exam of the limbs (abnormal tone, genu varus or valgus, leg strength, tender spots, leg lengths, scoliosis of the back, hip exam.)

Take care.

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