A case of leukemia-associated arthritis--identification of leukemic cells in synovial fluid by light microscopy

Acute Shoulder Monoarthritis in a Patient With Acute Myelomonocytic Leukemia With Novel Translocation t(5;13)

We present the case of a patient with acute myelomonocytic leukemia with trisomy 8 and novel translocation t(5;13). In addition to acute leukemia she had debilitating left shoulder arthritis due to granulocytic sarcoma formation in the joint space. Her shoulder pain did not improve during induction chemotherapy but she experienced rapid relief of symptoms with use of local radiation. Her leukemia was found to be primary refractory to chemotherapy and despite an attempt at salvage therapy she died 2 months after diagnosis.

Leukemic arthritis

Leukemic arthritis (LA) is an uncommon complication of both acute and chronic leukemias. LA occurs in 12% to 65% of childhood leukemia cases and 4% to 13% of adult leukemia cases. Involved joints usually are warm, swollen, and tender. This arthritis often is pauciarticular and preferentially involves large joints. LA occurs at any time during the course of leukemia and may be the presenting manifestation. Therefore, LA should be considered in the differential diagnosis of both adult and childhood rheumatic diseases. Establishing a diagnosis may be difficult and usually requires tissue biopsy. Newer immunochemical methods may help in the diagnosis of LA by demonstrating leukemic cells in synovial fluid. Therapy for the underlying leukemia is the treatment of choice. Decreasing joint pain often is the first sign of a clinical response to chemotherapy. A case report is presented and the literature on the subject is reviewed.