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Acute myelofibrosis and malignant hypercalcemia

J A Libnoch, K Ajlouni, W L Millman

    The American Journal of Medicine
    |March 1, 1977
    PubMed
    Summary

    This case study details a rare instance of severe hypercalcemia in a patient with acute myelofibrosis, a myeloproliferative disorder. Despite aggressive treatments, hypercalcemia remained uncontrolled, leading to a fatal outcome.

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    Area of Science:

    • Hematology
    • Oncology
    • Endocrinology

    Background:

    • Hypercalcemia is a rare but serious complication of myeloproliferative disorders.
    • Acute myelofibrosis is characterized by bone marrow fibrosis and abnormal hematopoiesis.

    Observation:

    • A 33-year-old male presented with severe hypercalcemia (22.5 mg/dl) and a hypercellular bone marrow.
    • Despite multiple therapies including saline diuresis, furosemide, mithramycin, parathyroidectomy, and corticosteroids, hypercalcemia was poorly managed.
    • Inappropriate parathyroid hormone (PTH) levels persisted post-parathyroidectomy; osteoclast-activating factor and prostaglandin E2 were negative.

    Findings:

    • The patient was diagnosed with acute myelofibrosis based on bone marrow findings: elevated leukocyte alkaline phosphatase, marrow aspirate failure, hematopoietic hyperplasia, blastic cell accumulation, and increased reticulin.
    • Chemotherapy with cytosine arabinoside and thioguanine resulted in profound hyperphosphatemia and hypocalcemia, preceding death.

    Implications:

    • This case highlights the diagnostic and therapeutic challenges of hypercalcemia in acute myelofibrosis.
    • The underlying mechanism of hypercalcemia in this rare presentation warrants further investigation.
    • Understanding such rare associations is crucial for improving patient outcomes in myeloproliferative neoplasms.

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