Abstract
Acute lymphoblastic leukaemia (ALL) is diagnosed by the presence of at least 20% lymphoblasts in the bone marrow. ALL may be aggressive and include the lymph nodes, liver, spleen, central nervous system (CNS), and other organs. Without early recognition and timely treatment, ALL will progress quickly and may have poor prognosis in clinical scenarios. ALL is a rare type of leukaemia in adults but is the most common type in children. Precipitating factors such as environmental radiation or chemical exposure, viral infection, and genetic factors can be associated with ALL. We report a rare case of ALL with symptomatic hypercalcaemia in an adult woman. The patient presented with general weakness, poor appetite, bilateral lower limbs oedema, consciousness disturbance, and lower back pain for 3 weeks. She had a history of cervical cancer and had undergone total hysterectomy, chemotherapy, and radiation therapy. Her serum calcium level was markedly increased, at 14.1 mg/dl at admission. Neck magnetic resonance imaging, abdominal sonography, abdominal computed tomography, and bone marrow examination were performed. Laboratory data, including intact parathyroid hormone (i-PTH), peripheral blood smear, and 25-(OH) D3, were checked. Bone marrow biopsy showed B cell lymphoblastic leukaemia. Chemotherapy was initiated to be administered but was discontinued due to severe sepsis. Finally, the patient died due to septic shock. This was a rare case of B cell ALL in an adult complicated by hypercalcaemic crisis, which could be a life-threatening emergency in clinical practice. Physicians should pay attention to the associated risk factors. Early recognition and appropriate treatment may improve clinical outcomes.
Highlights
P450 (CYP), glutathione S-transferase (GST), and aldehyde dehydrogenase (ALDH) families of enzymes have been found to impact the response to and/or toxicity associated with cyclophosphamide-based therapies [74]
This gene fusion event is associated with a poor prognosis, but the prognosis improved after treatment with tyrosine kinase inhibitors [77,78,79]
Another clinical feature of hypercalcaemia can be associated with t (17;19) in patients with Acute lymphoblastic leukaemia (ALL); this has been reported based on the effect of PTHrP [87]
Summary
Acute lymphoblastic leukaemia (ALL) is a malignancy in which lymphoid precursors replace the normal bone marrow. Peripheral blood may be a substitute for bone marrow for diagnosis. Hypercalcaemia (the presence of a corrected serum calcium level above 10.5 mg/dl) can be a rare clinical presentation of ALL. In patients with consciousness disturbance, hypercalcaemia, kidney injury, and bone pain, the possibility of malignancy should be considered. Aggressive screening for hypercalcaemia is important because some malignancies may share common features [1]. We presented an adult case of ALL with hypercalcaemic crisis. We investigated the risk factors, clinical manifestations, diagnosis, treatments, and outcomes of ALL in adults
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