Cause Analysis of Misdiagnosis and missed Diagnosis of 2 Cases of Childhood Acute Leukemia

WANG Yan-jing; LIU Yan; WANG Zhen

doi:10.3969/j.issn.1002-3429.2015.03.07

Abstract：Objective To explore the clinical characteristics of childhood acute leukemia, analyzes the causes of mis-diagnosis and missed diagnosis and put forward the preventive measures. Methods Retrospective analysis of clinical data of 2 cases of misdiagnosis and missed diagnosis of childhood acute leukemia admitted during 2012-2013 combined with literature a-nalysis were made. Results Case 1 had intermittent hip pain for 1 month and fever for 5 days. The pain was alleviated by it-self but relapsed. The patient was diagnosed as having synovitis of the hip in the other hospital's imaging and was given anti -inflammatory therapy without any improvement. In our outpatient department, the patient was diagnosed as having childhood rheumatism (multi-joint type) and was given anti - rheumatism treatment. The fever and pain were relieved, but there were still limited movement in many joints. After admission the patient was diagnosed as having systemic juvenile idiopathic arthri-tis. Re-examination of blood routine analysis showed blast cells. Bone marrow morphological examination suggested acute lym-phoblastic leukemia. Case 2 had fever, night sweat and fatigue for 6 days and a small amount of nasal bleeding for 3 days. He was given antifebrile and anti-infection therapy. The symptoms relapsed. After hospitalization, the patient was diagnosed as having upper respiratory tract infection. Review of blood routine test found blast cells, and bone marrow morphological exami-nation also suggested with acute lymphoblastic leukemia. Conclusion We should be alert for childhood leukemia if fever, pain of bone and infection have no improvement in patients after treatment. The crucial measure is to take bone marrow aspira-tion for morphological examination in order to make accurate diagnosis.