title: Pathological fractures in a patient with chronic lymphatic leucaemia without disease progression.
abstract: We describe a case of a 59-year-old woman with a medical history of upper leg pain and chronic lymphatic leucaemia (CLL), with known diffuse bone marrow infiltration and without signs of lymphatic or extra-lymphatic disease activity on positron emission tomography CT (PET-CT). She presented with multiple fractures of the pelvis, sacrum and left proximal femur as a result of a low energy fall. During admission, she sustained a non-traumatic fracture of the right proximal femur. Pathological fractures in patients with CLL are usually based on Richter's transformation or multiple myeloma. However, in the current case, a PET-CT and a bone marrow biopsy showed no signs of this. We did see a normoparathyroid hypercalcaemia in our patient, most likely caused by a CLL-based release of local osteoclast stimulating factors. A combination of fludarabine/cyclofosfamide/rituximab was started as treatment in combination with allopurinol and sodium bicarbonate to prevent further osteolysis.
authors.affiliation: Department of Surgery, Rijnland Ziekenhuis, Leiderdorp, The Netherlands.
authors.forename: Jasper C M
authors.initials: JC
authors.lastname: Langenberg
authors.affiliation: Department of Surgery, Rijnland Ziekenhuis, Leiderdorp, The Netherlands.
authors.forename: Willem-Maarten
authors.initials: WM
authors.lastname: Bosman
authors.affiliation: Department of Surgery, Rijnland Ziekenhuis, Leiderdorp, The Netherlands.
authors.forename: Jephta
authors.initials: J
authors.lastname: van den Bremer
authors.affiliation: Department of Surgery, Rijnland Ziekenhuis, Leiderdorp, The Netherlands.
authors.forename: Ewan D
authors.initials: ED
authors.lastname: Ritchie
mesh_terms: D000058:Accidental Falls; D000493:Allopurinol / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000293:injuries*; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D010014:Osteolysis / Q000517:prevention & control*; D010388:Pelvis / Q000000981:diagnostic imaging / Q000293:injuries*; D049268:Positron-Emission Tomography; D011859:Radiography; D000069283:Rituximab / Q000008:administration & dosage; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries*; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab; D000493:Allopurinol; D017693:Sodium Bicarbonate; D014740:Vidarabine; C024352:fludarabine