Unusual Presentation of Acute Leukaemia: A Tripod of Cases

Acute Leukemia is one of the common haematological malignancies encountered with varied clinical and haematological presentation. In acute leukaemia, complications like bleeding and infection cause significant morbidity and mortality, thus overshadowing the thromboembolic events. Among the various malignant haematological disorders, the association of thromboembolic events is often noted with acute promyelocytic leukemia, though the overall frequency of such events remains very low. Acute Lymphoblastic Leukemia (ALL) is, however, more common than Acute non-lymphoblastic Leukaemia. Usually patients present with symptoms because of cytopenias, organomegaly, lymphadenopathy and bone pain, including other skeletal abnormalities. Granular Acute lymphoblastic Leukaemia (G-ALL) may be misdiagnosed as Acute Myeloid Leukemia (AML) because of the presence of cytoplasmic granules in the lymphoblasts. This variant of ALL is usually noted in children, but may be seen in adults too. It is also important to note that asymptomatic skeletal involvement can be seen in 40-60% of patients with ALL, but pathological fractures and osteolytic lesions along with hypercalcemia at the time of presentation are very rare. Herein, we present a series of three cases of acute Leukemia presenting with unusual clinical and other rare haematological findings.