{"id":"https://openalex.org/W7225347150","doi":"https://doi.org/10.1155/crpe/6527741","title":"A Rare Case of Aleukemic B\u2010Cell Acute Lymphoblastic Leukemia Presenting as Rapidly Progressive Severe Low Back Pain in an Adolescent With a History of Anxiety and Depression","display_name":"A Rare Case of Aleukemic B\u2010Cell Acute Lymphoblastic Leukemia Presenting as Rapidly Progressive Severe Low Back Pain in an Adolescent With a History of Anxiety and Depression","publication_year":2026,"publication_date":"2026-01-01","ids":{"openalex":"https://openalex.org/W7225347150","doi":"https://doi.org/10.1155/crpe/6527741","pmid":"https://pubmed.ncbi.nlm.nih.gov/42991527","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/13736166"},"language":"en","primary_location":{"id":"doi:10.1155/crpe/6527741","doi":"https://doi.org/10.1155/crpe/6527741","is_oa":true,"landing_page_url":"https://doi.org/10.1155/crpe/6527741","pdf_url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1155/crpe/6527741","source":{"id":"https://openalex.org/S2764406097","display_name":"Case Reports in Pediatrics","issn_l":"2090-6803","issn":["2090-6803","2090-6811"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","jufo-1","norway-1","poland-20","russia-white-list-3"],"host_organization":"https://openalex.org/P4310319869","host_organization_name":"Hindawi Publishing Corporation","host_organization_lineage":["https://openalex.org/P4310319869","https://openalex.org/P4310320595"],"host_organization_lineage_names":["Hindawi Publishing Corporation","Wiley"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Case Reports in Pediatrics","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1155/crpe/6527741","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5160869055","display_name":"TingTing Huang","orcid":"https://orcid.org/0009-0002-9864-0067","observed_orcids":["https://orcid.org/0009-0002-9864-0067"]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"TingTing Huang","raw_affiliation_strings":["Pediatrics PrimaryOne Health  Columbus Ohio USA"],"raw_orcid":"https://orcid.org/0009-0002-9864-0067","affiliations":[{"raw_affiliation_string":"Pediatrics PrimaryOne Health  Columbus Ohio USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160869460","display_name":"Lingbin Meng","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I52357470","display_name":"The Ohio State University","ror":"https://ror.org/00rs6vg23","country_code":"US","type":"education","lineage":["https://openalex.org/I52357470"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Lingbin Meng","raw_affiliation_strings":["Division of Medical Oncology The Ohio State University College of Medicine  Columbus Ohio USA  osu.edu"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Medical Oncology The Ohio State University College of Medicine  Columbus Ohio USA  osu.edu","institution_ids":["https://openalex.org/I52357470"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5069518604","display_name":"Linghua Zheng","orcid":"https://orcid.org/0000-0001-7770-4098","observed_orcids":["https://orcid.org/0000-0001-7770-4098"]},"institutions":[{"id":"https://openalex.org/I52357470","display_name":"The Ohio State University","ror":"https://ror.org/00rs6vg23","country_code":"US","type":"education","lineage":["https://openalex.org/I52357470"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Linghua Zheng","raw_affiliation_strings":["Division of Medical Oncology The Ohio State University College of Medicine  Columbus Ohio USA  osu.edu"],"raw_orcid":"https://orcid.org/0000-0001-7770-4098","affiliations":[{"raw_affiliation_string":"Division of Medical Oncology The Ohio State University College of Medicine  Columbus Ohio USA  osu.edu","institution_ids":["https://openalex.org/I52357470"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5083633008","display_name":"Xue Na Han","orcid":"https://orcid.org/0000-0001-5016-2356","observed_orcids":["https://orcid.org/0000-0001-5016-2356"]},"institutions":[{"id":"https://openalex.org/I52357470","display_name":"The Ohio State University","ror":"https://ror.org/00rs6vg23","country_code":"US","type":"education","lineage":["https://openalex.org/I52357470"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Xue Han","raw_affiliation_strings":["Division of Microbiology Infection and Immunology The Ohio State University College of Medicine  Columbus Ohio USA  osu.edu"],"raw_orcid":"https://orcid.org/0000-0001-5016-2356","affiliations":[{"raw_affiliation_string":"Division of Microbiology Infection and Immunology The Ohio State University College of Medicine  Columbus Ohio USA  osu.edu","institution_ids":["https://openalex.org/I52357470"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5041186668","display_name":"Ephraim Abrokwa Ansa-Addo","orcid":"https://orcid.org/0000-0002-9352-1109","observed_orcids":["https://orcid.org/0000-0002-9352-1109","https://orcid.org/0009-0001-2829-6806"]},"institutions":[{"id":"https://openalex.org/I52357470","display_name":"The Ohio State University","ror":"https://ror.org/00rs6vg23","country_code":"US","type":"education","lineage":["https://openalex.org/I52357470"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Ephraim Ansa-Addo","raw_affiliation_strings":["Division of Medical Oncology The Ohio State University College of Medicine  Columbus Ohio USA  osu.edu"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Medical Oncology The Ohio State University College of Medicine  Columbus Ohio USA  osu.edu","institution_ids":["https://openalex.org/I52357470"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5100369170","display_name":"Feng Hong","orcid":"https://orcid.org/0000-0003-4377-7226","observed_orcids":["https://orcid.org/0000-0003-4377-7226","https://orcid.org/0000-0001-6709-2323"]},"institutions":[{"id":"https://openalex.org/I52357470","display_name":"The Ohio State University","ror":"https://ror.org/00rs6vg23","country_code":"US","type":"education","lineage":["https://openalex.org/I52357470"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Feng Hong","raw_affiliation_strings":["Division of Medical Oncology The Ohio State University College of Medicine  Columbus Ohio USA  osu.edu"],"raw_orcid":"https://orcid.org/0000-0001-6709-2323","affiliations":[{"raw_affiliation_string":"Division of Medical Oncology The Ohio State University College of Medicine  Columbus Ohio USA  osu.edu","institution_ids":["https://openalex.org/I52357470"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5100369170","https://openalex.org/A5160869055"],"corresponding_institution_ids":["https://openalex.org/I52357470"],"apc_list":{"value":790,"currency":"USD","value_usd":790},"apc_paid":{"value":790,"currency":"USD","value_usd":790},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.8689128,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"2026","issue":"1","first_page":"6527741","last_page":"6527741"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10950","display_name":"Acute Lymphoblastic Leukemia research","score":0.9682999849319458,"subfield":{"id":"https://openalex.org/subfields/2720","display_name":"Hematology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10950","display_name":"Acute Lymphoblastic Leukemia research","score":0.9682999849319458,"subfield":{"id":"https://openalex.org/subfields/2720","display_name":"Hematology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13374","display_name":"Hematological disorders and diagnostics","score":0.024399999529123306,"subfield":{"id":"https://openalex.org/subfields/2720","display_name":"Hematology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10185","display_name":"Lymphoma Diagnosis and Treatment","score":0.0012000000569969416,"subfield":{"id":"https://openalex.org/subfields/2734","display_name":"Pathology and Forensic Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/b-cell-acute-lymphoblastic-leukemia","display_name":"B-cell acute lymphoblastic leukemia","score":0.9340000152587891},{"id":"https://openalex.org/keywords/aleukemic-leukemia","display_name":"aleukemic leukemia","score":0.8330000042915344},{"id":"https://openalex.org/keywords/low-back-pain","display_name":"low back pain","score":0.7699999809265137},{"id":"https://openalex.org/keywords/adolescents","display_name":"adolescents","score":0.6150000095367432},{"id":"https://openalex.org/keywords/diagnostic-overshadowing","display_name":"diagnostic overshadowing","score":0.8299999833106995},{"id":"https://openalex.org/keywords/anxiety","display_name":"anxiety","score":0.5929999947547913},{"id":"https://openalex.org/keywords/depression","display_name":"depression","score":0.9990000128746033},{"id":"https://openalex.org/keywords/delayed-diagnosis","display_name":"delayed diagnosis","score":0.5789999961853027},{"id":"https://openalex.org/keywords/bone-marrow-involvement","display_name":"bone marrow involvement","score":0.6650000214576721},{"id":"https://openalex.org/keywords/lumbar-spine-mri","display_name":"lumbar spine MRI","score":0.4970000088214874},{"id":"https://openalex.org/keywords/lactate-dehydrogenase","display_name":"lactate dehydrogenase","score":0.9610000252723694},{"id":"https://openalex.org/keywords/inflammatory-markers","display_name":"inflammatory markers","score":0.9340000152587891},{"id":"https://openalex.org/keywords/differential-diagnosis-of-back-pain","display_name":"differential diagnosis of back pain","score":0.6439999938011169},{"id":"https://openalex.org/keywords/functional-decline","display_name":"functional decline","score":0.37400001287460327}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9488999843597412},{"id":"https://openalex.org/C160146798","wikidata":"https://www.wikidata.org/wiki/Q2471453","display_name":"Psychogenic disease","level":2,"score":0.6025999784469604},{"id":"https://openalex.org/C2776867660","wikidata":"https://www.wikidata.org/wiki/Q1814941","display_name":"Depression (economics)","level":2,"score":0.5202999711036682},{"id":"https://openalex.org/C558461103","wikidata":"https://www.wikidata.org/wiki/Q154430","display_name":"Anxiety","level":2,"score":0.5127000212669373},{"id":"https://openalex.org/C2780907711","wikidata":"https://www.wikidata.org/wiki/Q852163","display_name":"Low back pain","level":3,"score":0.47110000252723694},{"id":"https://openalex.org/C44575665","wikidata":"https://www.wikidata.org/wiki/Q1293405","display_name":"Lumbar","level":2,"score":0.453900009393692},{"id":"https://openalex.org/C2780007613","wikidata":"https://www.wikidata.org/wiki/Q546523","display_name":"Bone marrow","level":2,"score":0.4359999895095825},{"id":"https://openalex.org/C143409427","wikidata":"https://www.wikidata.org/wiki/Q161238","display_name":"Magnetic resonance imaging","level":2,"score":0.41609999537467957},{"id":"https://openalex.org/C2776501849","wikidata":"https://www.wikidata.org/wiki/Q5781808","display_name":"Back pain","level":3,"score":0.40389999747276306},{"id":"https://openalex.org/C2781179581","wikidata":"https://www.wikidata.org/wiki/Q2857712","display_name":"Family history","level":2,"score":0.385699987411499},{"id":"https://openalex.org/C2909962599","wikidata":"https://www.wikidata.org/wiki/Q180664","display_name":"Lymphoblastic Leukemia","level":3,"score":0.38519999384880066},{"id":"https://openalex.org/C2775934546","wikidata":"https://www.wikidata.org/wiki/Q179991","display_name":"Biopsy","level":2,"score":0.37619999051094055},{"id":"https://openalex.org/C2780724011","wikidata":"https://www.wikidata.org/wiki/Q1295316","display_name":"Emergency department","level":2,"score":0.37290000915527344},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.3621000051498413},{"id":"https://openalex.org/C206179267","wikidata":"https://www.wikidata.org/wiki/Q188952","display_name":"Medical history","level":2,"score":0.3531999886035919},{"id":"https://openalex.org/C527108885","wikidata":"https://www.wikidata.org/wiki/Q835153","display_name":"Physical examination","level":2,"score":0.3425000011920929},{"id":"https://openalex.org/C142724271","wikidata":"https://www.wikidata.org/wiki/Q7208","display_name":"Pathology","level":1,"score":0.34150001406669617},{"id":"https://openalex.org/C2781397520","wikidata":"https://www.wikidata.org/wiki/Q1474598","display_name":"Functional disorder","level":2,"score":0.3070000112056732},{"id":"https://openalex.org/C2778461978","wikidata":"https://www.wikidata.org/wiki/Q29496","display_name":"Leukemia","level":2,"score":0.3028999865055084},{"id":"https://openalex.org/C2776139714","wikidata":"https://www.wikidata.org/wiki/Q3480107","display_name":"Bone pain","level":2,"score":0.30160000920295715},{"id":"https://openalex.org/C2780801072","wikidata":"https://www.wikidata.org/wiki/Q837512","display_name":"Differential diagnosis","level":2,"score":0.3009999990463257},{"id":"https://openalex.org/C126838900","wikidata":"https://www.wikidata.org/wiki/Q77604","display_name":"Radiology","level":1,"score":0.2985999882221222},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.2849000096321106},{"id":"https://openalex.org/C2778426673","wikidata":"https://www.wikidata.org/wiki/Q326921","display_name":"Concussion","level":4,"score":0.27480000257492065},{"id":"https://openalex.org/C2778704086","wikidata":"https://www.wikidata.org/wiki/Q693058","display_name":"Chest pain","level":2,"score":0.2736999988555908},{"id":"https://openalex.org/C2780066322","wikidata":"https://www.wikidata.org/wiki/Q719444","display_name":"Lumbar puncture","level":3,"score":0.27070000767707825},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.2669000029563904},{"id":"https://openalex.org/C2780505380","wikidata":"https://www.wikidata.org/wiki/Q7142931","display_name":"Past medical history","level":2,"score":0.2635999917984009},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.25859999656677246},{"id":"https://openalex.org/C2777604421","wikidata":"https://www.wikidata.org/wiki/Q2303951","display_name":"Myelopathy","level":3,"score":0.2522999942302704}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.1155/crpe/6527741","doi":"https://doi.org/10.1155/crpe/6527741","is_oa":true,"landing_page_url":"https://doi.org/10.1155/crpe/6527741","pdf_url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1155/crpe/6527741","source":{"id":"https://openalex.org/S2764406097","display_name":"Case Reports in Pediatrics","issn_l":"2090-6803","issn":["2090-6803","2090-6811"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","jufo-1","norway-1","poland-20","russia-white-list-3"],"host_organization":"https://openalex.org/P4310319869","host_organization_name":"Hindawi Publishing Corporation","host_organization_lineage":["https://openalex.org/P4310319869","https://openalex.org/P4310320595"],"host_organization_lineage_names":["Hindawi Publishing Corporation","Wiley"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Case Reports in Pediatrics","raw_type":"journal-article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13736166","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13736166/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13736166/pdf/CRPE-2026-6527741.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Case Rep Pediatr","raw_type":"Text"},{"id":"pmid:42991527","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42991527","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Case reports in pediatrics","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.1155/crpe/6527741","doi":"https://doi.org/10.1155/crpe/6527741","is_oa":true,"landing_page_url":"https://doi.org/10.1155/crpe/6527741","pdf_url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1155/crpe/6527741","source":{"id":"https://openalex.org/S2764406097","display_name":"Case Reports in Pediatrics","issn_l":"2090-6803","issn":["2090-6803","2090-6811"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-c","jufo-1","norway-1","poland-20","russia-white-list-3"],"host_organization":"https://openalex.org/P4310319869","host_organization_name":"Hindawi Publishing Corporation","host_organization_lineage":["https://openalex.org/P4310319869","https://openalex.org/P4310320595"],"host_organization_lineage_names":["Hindawi Publishing Corporation","Wiley"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Case Reports in Pediatrics","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":1.0}],"study_designs":[{"display_name":"Case Report","id":"https://openalex.org/study-designs/case-report"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225347150.pdf","grobid_xml":"https://content.openalex.org/works/W7225347150.grobid-xml"},"referenced_works_count":18,"referenced_works":["https://openalex.org/W111527476","https://openalex.org/W1558704041","https://openalex.org/W2071640456","https://openalex.org/W2078769135","https://openalex.org/W2101690348","https://openalex.org/W2226811678","https://openalex.org/W2409262985","https://openalex.org/W2779954544","https://openalex.org/W2797504773","https://openalex.org/W2901711026","https://openalex.org/W3019575251","https://openalex.org/W3096184845","https://openalex.org/W3173999323","https://openalex.org/W4283156768","https://openalex.org/W4283311293","https://openalex.org/W4386877973","https://openalex.org/W4387911223","https://openalex.org/W4408537202"],"related_works":["https://openalex.org/W7124900547","https://openalex.org/W2779954544","https://openalex.org/W2911936533","https://openalex.org/W2050030068","https://openalex.org/W2134146629","https://openalex.org/W2901948379","https://openalex.org/W1566072176","https://openalex.org/W2327625975","https://openalex.org/W4214906558","https://openalex.org/W2054130036"],"abstract_inverted_index":{"Introduction:":[0],"Musculoskeletal":[1],"complaints":[2],"are":[3],"a":[4,48,52,145,173,178,261],"frequent":[5],"cause":[6],"of":[7,54,62,230,259,323],"pediatric":[8],"emergency":[9],"visits.":[10],"While":[11],"adolescent":[12],"back":[13,155,277],"pain":[14,65,156,278],"is":[15,30,306],"typically":[16],"benign,":[17],"it":[18],"can":[19,166],"occasionally":[20],"signal":[21,130],"underlying":[22,317],"malignancy.":[23],"Distinguishing":[24],"organic":[25],"pathology":[26,318],"from":[27],"functional":[28,109,191,282],"disorders":[29],"particularly":[31],"challenging":[32],"in":[33,157,161,176],"patients":[34],"with":[35,51,59,153,273],"pre-existing":[36],"psychiatric":[37,94,180,268],"comorbidities,":[38],"leading":[39],"to":[40,86,99,184,190,308,314],"potential":[41],"diagnostic":[42,100,171,324],"delays.":[43],"Case":[44],"Presentation:":[45],"We":[46],"report":[47],"17-year-old":[49],"female":[50],"history":[53,95,181],"anxiety":[55],"and":[56,66,75,119,212,219,233,243,246,265,288,297,319],"depression":[57],"presenting":[58],"two":[60],"weeks":[61],"severe":[63,187],"lumbar":[64],"progressive":[67],"gait":[68],"difficulty.":[69],"Initial":[70],"evaluations,":[71],"including":[72,236],"spinal":[73],"radiography":[74],"complete":[76],"blood":[77,210],"count,":[78],"were":[79,83,105],"unremarkable.":[80],"Her":[81],"symptoms":[82,91,189,218],"initially":[84,151,224],"attributed":[85],"musculoskeletal":[87,311],"strain.":[88],"However,":[89],"as":[90,241],"persisted,":[92],"her":[93],"may":[96,205,299],"have":[97],"contributed":[98],"overshadowing":[101],"when":[102,250,270,302],"psychogenic":[103,193],"factors":[104],"subsequently":[106],"considered.":[107],"Rapid":[108],"deterioration":[110,222],"prompted":[111],"further":[112,168],"workup,":[113],"revealing":[114],"markedly":[115],"elevated":[116],"inflammatory":[117,244],"markers":[118],"lactate":[120],"dehydrogenase":[121],"(LDH).":[122],"Magnetic":[123],"resonance":[124],"imaging":[125,248],"(MRI)":[126,249],"demonstrated":[127],"diffuse":[128],"marrow":[129,134,203],"abnormalities.":[131],"Subsequent":[132],"bone":[133,202],"biopsy":[135],"confirmed":[136],"B-cell":[137],"acute":[138],"lymphoblastic":[139],"leukemia":[140],"(B-ALL).":[141],"Cytogenetics":[142],"analysis":[143],"showed":[144],"normal":[146,208],"karyotype.":[147],"Discussion:":[148],"ALL":[149],"rarely":[150],"presents":[152],"isolated":[154],"adolescents,":[158],"commonly":[159],"resulting":[160],"delayed":[162],"diagnosis.":[163],"This":[164,195,254],"delay":[165],"be":[167,300],"exacerbated":[169],"by":[170,280],"overshadowing,":[172],"cognitive":[174],"bias":[175],"which":[177],"patient's":[179],"leads":[182],"clinicians":[183],"prematurely":[185],"attribute":[186],"somatic":[188],"or":[192,275],"etiologies.":[194],"case":[196,255],"also":[197],"highlights":[198],"that":[199],"early":[200],"leukemic":[201],"infiltration":[204],"occur":[206],"despite":[207,223,284],"peripheral":[209],"counts":[211],"unrevealing":[213],"plain":[214],"radiographs.":[215],"Therefore,":[216],"persistent":[217,274],"rapid":[220,281],"clinical":[221,304],"reassuring":[225,286],"investigations":[226],"should":[227],"prompt":[228],"reconsideration":[229],"the":[231,257,303,321],"diagnosis":[232,264],"additional":[234,294],"evaluation,":[235],"selected":[237],"laboratory":[238,295],"studies,":[239],"such":[240,292],"LDH":[242],"markers,":[245],"advanced":[247],"clinically":[251],"indicated.":[252],"Conclusion:":[253],"underscores":[256],"importance":[258],"maintaining":[260],"broad":[262],"differential":[263],"looking":[266],"beyond":[267],"comorbidities":[269],"evaluating":[271],"adolescents":[272],"nocturnal":[276],"accompanied":[279],"decline,":[283],"initial":[285],"radiographs":[287],"hematologic":[289],"studies.":[290],"In":[291],"patients,":[293],"assessment":[296],"MRI":[298],"considered":[301],"course":[305],"disproportionate":[307],"an":[309],"expected":[310],"injury,":[312],"helping":[313],"identify":[315],"serious":[316],"reduce":[320],"risk":[322],"delay.":[325]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-11-06T00:00:00"}