Periosteal Changes in a Case of Lymphatic Leukemia

Abstract

The radiographic findings in this case being rather unusual and uncommon and a review of the literature within the past few years failing to disclose any other cases with similar radiographic changes, a report of this case is warranted. V. R., age two years and ten months, was admitted to the hospital September 25, 1925, for progressive weakness and inability to walk. The family and past history were essentially negative. There was no abnormality as regards birth and feeding. There was no history of any previous illness, and physical and mental development up to the time of admission were normal. The present illness dated back to seven months before admission to the hospital (February, 1925), when the child began to complain of an inability to walk. On the following day the mother noticed that both legs were swollen. The next day the upper extremities, from the elbows down, were swollen. The swelling was hot and tender, but there was no evidence of any redness. The child, however, did not run any temperature. Two months after the onset of the present illness the mother noticed that she had developed a morbid pallor. She had lost twenty pounds in the seven months from the onset of her present symptoms to the time of admission to the hospital. Physical examination revealed a child who looked chronically ill and apathetic. The face and mucous membranes were pale, and the eyes puffy. The submaxillary and inguinal nodes were definitely enlarged, while the axillary and epitrochlear showed no evidence of enlargement. The tonsils were hypertrophied but not diseased. The spleen was enlarged to about two inches below the costal margin. The child was able to move her extremities voluntarily but cried when they were manipulated by the examiner. Repeated blood counts showed a red cell count varying from 1,200,000 to 3,800,000, with a hemoglobin ranging from 20 to 75 per cent. The white cell count varied from 1,900 to 147,000, with four aleukemic periods during two months, the small mononuclear lymphocyte predominating at all times. Abnormal cells noted were nucleated reds, macrocytes, myelocytes, lymphoblasts, normoblasts and myeloblasts. Anisocytosis and poikilocytosis were also noted. The Wassermann reaction was negative. The temperature during the stay at the hospital was always above normal and at times reached 104 degrees. Ecchymoses developed at various times and in different parts of the body, and on one occasion the child had a bloody bowel movement. The roentgen findings of all the long bones, including the metacarpals and metatarsals (Figs. 1, 2 and 3), showed a slight elevation of the periosteum, with some productive changes. There was no evidence present either clinically or radiographically, to suggest rickets, scurvy or syphilis. The child died November 30, 1925, and autopsy revealed the following: External examination of the body showed a marked general anemia.