[Malignant hypercalcaemia revealing acute lymphoblastic leukemia: case report]

Malignant hypercalcaemia is a metabolic emergency. Its association with solid tumors is common, whereas it has been rarely described in patients with malignant hemopathies other than multiple myeloma and T-cell leukemias/T-cell lymphomas associated with lymphotropic virus type I (HTLV-I). We here report the case of a female patient with acute lymphoblastic leukemia revealed by malignant hypercalcaemia and pathological fracture of the humerus. Laboratory tests showed aregenerative, normocytic-normochromi anemia, hypercalcaemia (163mg/l), renal failure, creatinine (22mg/l), glomerular filtration rate 26 ml/min and low parathyroid hormone (PTH) (9.9pg/ml). X-ray of the right upper limb showed pathological fracture of humerus. Myelogram and immunophenotyping confirmed the diagnosis of LAL-B. The patient received urgent treatment for hypercalcaemia and the underlying malignancy. This study focuses attention on this atypical condition occurring during acute leukemias and on its diagnostic and therapeutic issues.