Osteolytic lesions as a presenting sign of acute myeloid leukemia

Osteolytic lesions rarely occur in acute myeloid leukemia (AML). We reporte d an atypical form of the disease, with marrow fibrosis and osteolytic lesi ons, in a 17-year-old patient, whose main symptom was lumbar pain. Diagnosi s of AML was established by bone marrow and lymph node histological analysi s. Computed tomography (CT) scan and Tc-99m-MDP bone scintyscan revealed os teolytic lesions. After remission-induction, bone marrow aspirate and biops y showed no evidence of leukemic infiltration, nevertheless bone abnormalit ies persisted on Tc-99m-MDP bone scintyscan, suggesting residual disease. S uspect bone areas were irradiated with symptomatic improvement and Tc-99m-M DP bone scintyscan showed the appearance of more condensed bone compared wi th the pre-radiotherapy pattern. Twelve months later he was readmitted to t he hospital due to relapse of AML and died of sepsis within a few weeks. Th is report illustrates the usefulness of histological studies to establish d iagnosis of AML in atypical cases, as well as the importance of CT scan and bone scintigraphy scan for the identification of osteolytic lesions. It al so provides additional data as evidence that although osteolytic lesions in dicate an adverse prognosis in AML, local irradiation results symptomatic r elief.