Vertebral Compression Fractures—The First Manifestations in the Elderly Acute Lymphoblastic Leukemia

BACKGROUND: Acute lymphoblastic leukemia (ALL) is reported to be the most common malignancy in children, but is less common in adults. Though vertebral compression fractures have been reported as initial signs of ALL in children, to the best of our knowledge, there have not been any previous reports of vertebral compression fractures as an initial manifestation of ALL in elderly people. CASE PRESENTATION: Here we reported a 65-year-old man who was admitted with a 1-month history of progressive chest and back pain and worsening pain after heavy lifting. Considering the histories of osteoporosis, minor trauma and normal peripheral blood counts, it was firstly misdiagnosed as spinal osteoporotic compression fractures which were caused by low-energy injuries. The patient was definitely diagnosed as ALL after bone marrow biopsy. CONCLUSION: ALL must be considered in the differential diagnosis with acute vertebral compression fracture. Considering that bony lesions may precede clinical findings, knowledge of radiographic and orthopedic appearances of leukemia are important in order to initiate earlier treatment to avoid the progressive damage and improve their survival rates. we recommend bone marrow biopsy in vertebroplasty to avoid misdiagnosis.