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Pulmonary alveolar septal calcinosis causing progressive respiratory failure in acute lymphoblastic leukemia in

D Sinniah, B H Landing, S E Siegel

    Pediatric Pathology
    |January 1, 1986
    PubMed

    Insights

    Pulmonary alveolar septal calcification, a rare complication in children with acute lymphoblastic leukemia (ALL), can lead to fatal respiratory failure. Early diagnosis is crucial but challenging, as symptoms mimic other conditions.

    Area of Science:

    • Pediatric Oncology
    • Pulmonary Medicine
    • Pathology

    Background:

    • Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
    • Respiratory complications can arise in patients with ALL.
    • Accurate diagnosis of pulmonary conditions in ALL patients is critical.

    Observation:

    • Two pediatric patients with ALL presented with a rare syndrome of pulmonary alveolar septal calcification, pneumothorax, and pneumomediastinum.
    • Clinical and radiological findings initially suggested pulmonary edema or infection.
    • Diagnosis was confirmed post-mortem, highlighting diagnostic challenges.

    Findings:

    • One patient had familial hyperparathyroidism; the other showed secondary hyperparathyroidism with osteitis fibrosa, suggesting hypercalcemia as a cause.
    • Pulmonary calcinosis may result from hypercalcemia due to parathormone or prostaglandin-secreting tumors.
    • Pneumothorax and pneumomediastinum might be caused by the rupture of calcified alveolar septa during mechanical ventilation.

    Implications:

    • This rare complication underscores the importance of considering metabolic derangements in ALL patients with respiratory distress.
    • Further research is needed to determine if early diagnosis and intervention can improve outcomes.
    • Understanding the pathogenesis of pulmonary calcinosis in ALL may lead to novel therapeutic strategies.

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