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CD45(-) Acute Lymphoblastic Leukemia Characterized by Migratory Arthritis, Thrombocytosis, Thrombosis and Early Relapse: Case Report and Literature Review
Michelle Gurnari Tawa, Patty Ku and Theodore Zwerdling
We describe an unusual case of pre-B cell Acute Lymphoblastic Leukemia (ALL) presenting with recurrent migratory arthritis, thrombocytosis without peripheral blasts, who developed a saphenous vein thrombosis prior to starting chemotherapy. Immunophenotyping, some molecular analysis and early bone marrow response (day 15 of induction) were consistent with good prognosis. However, the patient developed very early Central Nervous System (CNS) relapse two months after induction chemotherapy. The constellation of clinical presentation, laboratory evaluations and response to treatment may allow identification of new prognostic features designed to stratify treatment and predict outcome.