title: [Hypercalcemia and multiple osteolytic lesions associated with proinflammatory cytokines in a patient with acute lymphoblastic leukemia].
abstract: A 70-year-old man was admitted to the hospital with left ankle pain, also exhibiting severe consciousness disturbance. Laboratory findings showed not only hypercalcemia, but also increased serum levels of PTHrP and a few of proinflammatory cytokines, such as TNF-alpha, and IL-6. The X-ray and CT examinations revealed multiple osteolytic lesions, including the left tibia and fibula. Bone marrow aspiration revealed increased lymphoblasts (48%), and the patient was diagnosed as having acute lymphoblastic leukemia (ALL, L2). The hypercalcemia was successfully treated with calcitonin and bisphosphonate, and subsequently his consciousness status recovered rapidly. The bone marrow lymphoblast count decreased following combination chemotherapy, and a tendency towards improvement of the left ankle pain was also noted. However, he died of acute pneumonia and gastrointestinal bleeding. The postmortem findings showed leukemic cell involvement of the left tibia. The present case suggested that not only humoral hypercalcemia or local osteolytic hypercalcemia, but also proinflammatory cytokines were associated with multiple osteolysis and hypercalcemia.
authors: Division of Internal Medicine, Aiiku Hospital, Sapporo.
authors: Akio
authors: A
authors: Mori
authors: Nobuyasu
authors: N
authors: Toyoshima
authors: Makoto
authors: M
authors: Saito
authors: Tetsuo
authors: T
authors: Oka
authors: Tatsuro
authors: T
authors: Irie
authors: Masanobu
authors: M
authors: Morioka
mesh_terms: D000368:Aged; D016207:Cytokines / Q000502:physiology*; D005360:Fibula / Q000000981:diagnostic imaging; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D010014:Osteolysis; D044162:Parathyroid Hormone-Related Protein / Q000097:blood; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000503:physiopathology*; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D016207:Cytokines; D015850:Interleukin-6; D044162:Parathyroid Hormone-Related Protein; D014409:Tumor Necrosis Factor-alpha