# A Case Report of Acute Lymphoblastic Leukemia Presenting as Bilateral Knee Pain in a Healthy Runner

## TL;DR

A healthy 34-year-old runner with no prior health issues was diagnosed with acute lymphoblastic leukemia after presenting with knee pain, highlighting the disease's rare and non-specific symptoms in adults.

## Contribution

This case report highlights the rare presentation of ALL in an adult as bilateral knee pain, emphasizing the need for vigilance in atypical cases.

## Key findings

- ALL can present with non-specific symptoms like bilateral knee pain in adults.
- The patient exhibited signs of tumor lysis syndrome, contributing to premature death.
- Clinicians should maintain high suspicion for rare conditions in 'bounce-back' patients.

## Abstract

Acute lymphoblastic leukemia (ALL) is typically a childhood disease but may present in older patients in rare occurrences. Due to its significant morbidity and mortality, early diagnosis is crucial. The symptoms of ALL may be non-specific, making the initial diagnosis difficult leading to delayed treatment.

We present the case of a 34-year-old, healthy male runner presenting to the emergency department with a common complaint of bilateral knee pain, who was ultimately diagnosed with ALL with signs of tumor lysis syndrome leading to premature death.

We discuss the presenting symptoms of acute lymphoblastic leukemia, which may include joint or knee pain as well as leukemic arthritis. We further discuss the importance of clinicians maintaining a high level of suspicion for the “bounce-back” patient and avoiding taking cognitive shortcuts.