Vertebral compression fracture as an initial presentation of pediatric acute lymphoblastic leukemia in a 4-year-old girl

Abstract

Vertebral body compression fracture rarely occurs in acute lymphoblastic leukemia (ALL) at the time of diagnosis. A 4-year-old girl presented with back pain. Magnetic resonance imaging revealed a compression fracture of the 10th thoracic vertebra and a tumor beside the vertebral body. We diagnosed her as having B precursor ALL on the basis of findings of bone marrow examination and started chemotherapy. Following treatment, she remained in complete remission. Before chemotherapy, the bone mineral density of the 1st to 4th lumbar vertebra decreased to −4.5 SD. Although the height of most vertebral bodies temporarily decreased, compression fracture did not recur during chemotherapy. Clinical features of ALL with vertebral compression fracture as a presenting symptom are still unclear. The presence of a vertebral compression fracture at the time of diagnosis of ALL may increase the risk of refracture and failure of vertebral body repair. Early bone mineral density-promoting interventions should, therefore, be considered for this condition.