Abstract
Primary bone manifestation associated with hypercalcemia is an infrequent presentation of acute lymphoblastic leukemia (ALL) in children. An 8-year-old girl was admitted with bone and abdomen pain, vomiting, fever, headache, anemia, elevated serum calcium and normal parathyroid hormone levels. Bone radiographs: osteolytic lesions. Bone marrow biopsy showed an infiltration by ALL with immunohistochemical positivity for CD45, CD20, CD79a, TdT and CD10, clinically characterized by hypercalcemia, multifocal osteolytic lesions and single cytopenia. Bone marrow biopsy was a relevant aid in establishing the diagnosis of multifocal osteolytic lesions, associated with hypercalcemia.
Highlights
Acute lymphoblastic leukemia (ALL) is the most common hematologic malignancy of the childhood, occurring under six years of age in 75% of the cases
We reported an unusual case of a child with lytic lesions, hypercalcemia and peripheral blood single cytopenia, whose diagnosis of ALL was established by the bone marrow biopsy
Malignancies are a major cause of elevated serum calcium levels, designating the phenomenon known as hypercalcemia of malignancy
Summary
Acute lymphoblastic leukemia (ALL) is the most common hematologic malignancy of the childhood, occurring under six years of age in 75% of the cases. The clinical and laboratory presentation without leukocytosis is infrequent(1). Bone lesions in patients with ALL are described in the context of initial manifestations or during its evolution and/or treatment. The association with hypercalcemia, a metabolic emergency, is observed between 0.6% and 4.8% of children with this cancer(2-4). We reported an unusual case of a child with lytic lesions, hypercalcemia and peripheral blood single cytopenia, whose diagnosis of ALL was established by the bone marrow biopsy
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