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Calf pain: Atypical presentation of acute lymphoblastic leukemia mimicking deep venous thrombosis

Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children, representing nearly one-third of all pediatric malignancies. The clinical manifestations generally include symptoms that reflect bone marrow infiltration and extramedullary disease, like fatigue, pallor, petechiae, bleeding, fever, weight loss, dyspnea and bone pain. In addition, leukemic spread may manifest as lymphadenopathy and hepatosplenomegaly. Central nervous system compromise, testicular enlargement, renal mass and symptoms of hypocalcemia are rarely observed at the time of initial diagnosis and have been reported only sporadically in the literature.