title: Childhood aleukemic leukemia with hypercalcemia and bone lesions mimicking metabolic bone disease.
abstract: A 16 year-old boy presented with severe hypercalcemia, diffuse osteolytic lesions and vertebral fractures. He was initially diagnosed with metabolic bone disease, and the hypercalcemia responded to treatment with intravenous hydration and bisphosphonates. However, the intact parathormone level was normal. He had no lymphadenopathy or organomegaly. The only hematological abnormality was moderate anemia, which prompted bone marrow studies leading to a diagnosis of acute lymphoblastic leukemia (ALL). He was treated with standard chemotherapy and achieved remission as well as resolution of his skeletal symptoms. We discuss the diagnostic challenges of this rare entity of aleukemic leukemia with hypercalcemia and lytic bone lesions, and review all the previously reported pediatric literature.
authors.affiliation: Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Prasanth
authors.initials: P
authors.lastname: Ganesan
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
authors.forename: Ritu
authors.initials: R
authors.lastname: Gupta
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
mesh_terms: D000293:Adolescent; D001772:Blood Cell Count; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D003937:Diagnosis, Differential; D004164:Diphosphonates / Q000627:therapeutic use; D004358:Drug Therapy; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology* / Q000473:pathology; D008297:Male; D010014:Osteolysis / Q000209:etiology* / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D010281:Parathyroid Hormone