Periosteal Ossification in Myelogenous Leukemia

The occurrence of pain in the joints and bones in the course of leukemia, of both the lymphatic and the myeloid type, has been recognized by clinicians for many years (Naegeli,¹Poynton and his co-workers²and Smith³). These manifestations have consisted of not only pain and tenderness in the long bones, but also swelling, tenderness and redness in the joints clinically indistinguishable from that which occurs in acute rheumatic fever. These findings usually receive their correct interpretation on the basis of the existence of the hematologic and physical features of leukemia, and little diagnostic difficulty is encountered. Several cases in the aleukemic and acute states, in which the existence of leukemia was less obvious because of the absence of changes in the circulating blood and clinically demonstrable involvement of the liver, spleen and lymph nodes, have presented diagnostic problems in which, particularly, the differentiation from acute rheumatic