• Wei Liu, Guangfeng Chen, Bing Xu, Suping Sun, Jingzhen Tian, and Yingying Zhang.
• College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine.
• Medicine (Baltimore). 2020 Apr 1; 99 (15): e19806.

RationaleAcute lymphoblastic leukemia (ALL) has acute and severe onset characterized by fever, moderate to severe anemia, bone and joint pain, and sternal tenderness. It is easy to be misdiagnosed as rheumatic disease when joint pain is the first symptom.Patient ConcernsA male Han, 18 years of age was admitted on July 15th, 2016 for multi-joint swelling and pain with intermittent fever for half a year which had aggravated in the last 10 days.DiagnosisBased on symptoms, imaging, family history, and blood tests, he was first diagnosed with ankylosing spondylitis, but he was refractory to treatment. Bone marrow biopsy then revealed acute B-lymphoblastic leukemia (possibility Pro-B-ALL).InterventionsThe patient was transferred to the hematology department on July 23rd, 2016 for chemotherapy.OutcomesNo joint pain occurred during follow-up, which ended on November 4th, 2018.LessonsALL may present with symptoms suggestive of rheumatic diseases like ankylosing spondylitis. Physicians should be aware of this possibility, especially in young patients.

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