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Massive metastatic pulmonary calcification in an infant with aleukemic monocytic leukemia
Insights
Severe hypercalcemia in an infant with leukemia led to widespread metastatic calcification, particularly in the lungs. Early detection of pulmonary calcification using Von Kossa staining is crucial for infants with this rare condition.
Area of Science:
- Pediatric Oncology
- Pathology
- Nephrology
Background:
- Aleukemic monocytic leukemia can present with severe hypercalcemia and osteoclastic bone resorption.
- Metastatic calcification is a rare but serious complication in infants, often presenting with respiratory distress.
Observation:
- An 18-month-old infant with leukemia developed refractory hypercalcemia and rapidly progressive respiratory failure.
- Pulmonary radiopacities were noted, and lung biopsy revealed extensive metastatic septal calcifications via Von Kossa staining.
- Autopsy confirmed widespread calcifications in lungs, heart, liver, kidneys, vessels, and skin.
Findings:
- Von Kossa staining is highly sensitive for detecting minute pulmonary calcifications, which can mimic infectious infiltrates radiographically.
- Metastatic pulmonary calcification is infrequently described in infants, with premortem diagnosis being rare.
- The extensive calcification contributed to the infant's hypoxemia and hypercapnia.
Implications:
- This case highlights the importance of considering metastatic calcification in infants with leukemia and hypercalcemia presenting with respiratory symptoms.
- The utility of Von Kossa staining in diagnosing subtle pulmonary calcifications is emphasized.
- Prompt recognition and management of metastatic calcification are critical for improving outcomes in affected infants.
Abstract:
An 18-month-old infant with aleukemic monocytic leukemia and osteoclastic bone resorption demonstrated in the pelvis, vertebral bodies, and ribs developed severe refractory hypercalcemia. Bilateral interstitial pulmonary radiopacities developed rapidly, accompanied by hypoxemia and hypercapnea. Von Kossa staining of an open lung biopsy revealed extensive, finely granular metastatic septal calcifications not apparent on H&E-stained sections. Autopsy revealed the massive nature of the pulmonary calcinosis and the presence of additional calcifications in the atrial subendocardium, liver, kidneys, vessels, and skin. Metastatic pulmonary calcification has been infrequently described in infants, and premortem detection of such deposits has been rarely reported. The Von Kossa stain is useful in detecting minute pulmonary calcifications which may radiographically simulate infiltrates of infectious origin.