B-CELL LYMPHOMA MASQUERADING AS REFRACTORY OSTEOMYELITIS OF THE RIGHT KNEE JOINT IN A PEDIATRIC PATIENT: A CASE REPORT
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This case report details the diagnostic challenge encountered in a 9-year-old unvaccinated male who presented with persistent right leg/knee pain, initially misdiagnosed as acute osteomyelitis. Despite multiple courses of antibiotics over several months, the patient's condition deteriorated, prompting further investigation into atypical infections and ultimately leading to a diagnosis of B-cell lymphoma (Vargas-Gaspar et al., 2020). This case underscores the critical importance of considering hematological malignancies in the differential diagnosis of pediatric patients with unremitting musculoskeletal pain and poor response to conventional osteomyelitis treatment, even when initial imaging studies are inconclusive (Pham et al., 2017) (Desmond et al., 2019). Such presentations often mimic infectious processes, leading to diagnostic delays that can have significant implications for patient outcomes (Wobma et al., 2019). Early recognition of these oncologic mimickers is crucial for timely intervention and improved prognosis (Ebrahimpour et al., 2019). The protracted course and atypical response to therapy in this particular case highlight the necessity for a broadened diagnostic perspective when initial management strategies for presumed osteomyelitis fail (Qin et al., 2021). This case emphasizes the need for clinicians to maintain a high index of suspicion for underlying malignancies, such as lymphoma or leukemia, particularly when faced with persistent bone pain, fever, and non-improving symptoms despite aggressive antibiotic regimens (Desmond et al., 2019). Furthermore, the diagnostic ambiguity between osteomyelitis and certain malignancies, such as lymphoma, can be pronounced due to overlapping clinical and imaging features, often necessitating histopathological examination for definitive diagnosis (Ebrahimpour et al., 2019). This case illustrates a diagnostic pitfall where the initial presentation closely mirrored an infectious process, delaying the identification of an underlying neoplastic condition, which is a common challenge in pediatric oncology (Desmond et al., 2019). Given the broad differential for progressive lower extremity musculoskeletal pain in children, which includes infectious, musculoskeletal, and oncological etiologies, a comprehensive and iterative diagnostic approach is essential (Day, 2025). This report aims to elucidate the diagnostic journey, treatment course, and critical lessons learned from this challenging case. The prolonged symptomatic period and therapeutic unresponsiveness necessitate a thorough examination of differential diagnoses beyond common infectious etiologies (Desmond et al., 2019) (Vargas-Gaspar et al., 2020).
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