Hypercalcaemia with disseminated osteolytic lesions: a rare presentation of childhood acute lymphoblastic leukaemia

Abstract

Acute lymphoblastic leukaemia (ALL) presenting with hypercalcaemia and lytic bone lesions is a rare event in children unlike adults. We report a 15-year-old boy with acute lymphoblastic leukaemia and hypercalcaemia. He had normal peripheral blood count and the peripheral smear did not show blast. The bone marrow examination revealed Pre B ALL phenotype with aberrant expression of CD13. The skeletal survey showed osteolytic lesions. Hypercalcaemia was treated with zoledronic acid. He attained remission only after three lines of intensive chemotherapy protocols. He was planned for stem cell transplant. Meanwhile, he relapsed and died. A review of the literature also highlights characteristics similar to our case.

Severe Hypercalcemia in a Child With Acute Lymphoblastic Leukemia Relapse

“…Only 2 case reports (11.5-and 15-year-old boys) have been found in English literature about ZA use in hypercalcemia of children with the diagnosis of ALL. 20,21 Hypercalcemia was diagnosed at the time of initial diagnosis of ALL in both cases, whereas it was developed during relapse in our case. ZA had been successfully used as a first-line agent in the treatment of hypercalcemia in both cases.…”

“…ZA had been successfully used as a first-line agent in the treatment of hypercalcemia in both cases. 20,21 In contrast, pamidronate was used as a first-line treatment agent in our case, because ZA was unavailable in our clinic despite it being a more potent agent than pamidronate. 22 In addition, calcium normalization has been reported at the fourth day of ZA administration in a study on adults with malignancy-associated hypercalcemia.…”

Hypercalcemia, multiple osteolytic lesions, and acute renal failure: a rare presentation of B-cell acute lymphoblastic leukemia

“…Shimonodan et al [9] revealed the fact that elevated PTHrPs in ALL come from lymphoblasts, associated with its frequent relapses and poor prognosis. Additionally, other leukemic blasts-producing cytokines including transforming growth factor-α, tumor necrosis factor, interleukin-1, and prostaglandin E2 may affect these phenomena [10]. Although leukemic infiltration of the kidney is usually asymptomatic, it can lead to bilateral renal enlargement, acute kidney injury (AKI), or secondary hypertension [11].…”

Apresentação Atípica de Leucemia Linfoide Aguda em Criança: Relato de Caso

“…Há controvérsias sobre a mudança do prognóstico relacionado com a presença de lesões osteolíticas e hipercalcemia em pacientes com LLA. Alguns estudos sugerem que não existe relação entre a presença das lesões e o pior prognóstico de pacientes com LLA 9,12,19,20 . Há evidência na literatura de que o período de remissão da doença é reduzido em pacientes com lesões osteolíticas 11 .…”