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Multiple Osteolytic Lesions Causing Hypercalcemia: A Rare Presentation of Acute Lymphoblastic Leukemia
Khalid Mahmood1, Muhammad Ubaid2, Syeda Taliya Rizvi2
1Faculty of Medicine and Allied Health Sciences, Dow University of Health Sciences, Karachi, Pakistan.
Case Reports in Medicine
|August 12, 2017
Summary
Acute lymphoblastic leukemia (ALL) involves abnormal white blood cell proliferation, causing anemia and bleeding. This case highlights a rare presentation of ALL in an adult with severe hypercalcemia and bone lesions.
Area of Science:
- Hematology
- Oncology
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer characterized by the rapid proliferation of malignant lymphoblasts, leading to bone marrow failure.
- Clinical manifestations typically include anemia, thrombocytopenia, and infections, with bone pain occurring in a significant minority of cases.
Observation:
- A 22-year-old male presented with fatigue and bone pain, unusual symptoms for adult ALL.
- Despite normal parathyroid levels, he exhibited severe hypercalcemia and multiple osteolytic lesions, which are uncommon in ALL.
- Peripheral blood smear revealed anemia but no blasts, contrasting with a bone marrow biopsy showing over 30% blasts.
Findings:
- The patient's presentation with severe hypercalcemia and osteolytic lesions is atypical for acute lymphoblastic leukemia.
- Bone marrow biopsy confirmed a diagnosis of ALL with a high blast percentage and CD10 positivity.
Implications:
- This case underscores the importance of considering ALL in adults presenting with unexplained bone pain and hypercalcemia, even with atypical peripheral smear findings.
- Highlights the diagnostic challenge and the need for thorough bone marrow examination in suspected cases.
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