Abstract:
Background. Bone marrow necrosis (BMN) is a rare entity which presents with bone pain, fever, and peripheral cytopenia. Acute
lymphoblastic leukaemia (ALL) is characterized by malignant proliferation of immature lymphocytes, and patients usually present
with fatigue and bleeding manifestations. Presentation with BMN is an extremely rare finding and only few cases had been
reported in the literature. Case Presentation. A 22-year-old male presented with nocturnal lower back ache, pleuritic central chest
pain, and fever for two weeks. He was extensively investigated for a cause. His investigations revealed pancytopenia with severe
neutropenia. Initial bone marrow aspiration and biopsy did not provide a positive result due to extensive necrosis. However,
immunohistochemical analysis of few immature lymphoid cells on repeated BM biopsy showed evidence of acute lymphoblastic
leukaemia. Conclusions. ALL usually presents with fatigue and bleeding manifestations. Presentation with BMN is extremely rare.
*e diagnosis was extremely challenging as this patient had only occasional atypical cells in the peripheral blood film and the
repeat bone marrow (BM) biopsy showed extensive necrosis.
