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Osteolytic Bone Lesions, Hypercalcemia, and Renal Failure: A Rare Presentation of Childhood Acute Lymphoblastic Leukemia

Keith Peterson, Rodney Higgins, Tyler Peterson, Yoav Messinger


Introduction: Pediatric acute lymphoblastic leukemia (ALL) rarely presents with hypercalcemia and diffuse osteolytic lesions.

Presentation of Case: We report the case of a 17 year-old male with hypercalcemia, thrombocytopenia, and renal failure. Skeletal x-rays showed extensive osteolytic lesions. Pamidronate was used for treatment of hypercalcemia when calcitonin failed to maintain calcium levels within the normal range. Parathyroid hormone-related peptide (PTHrP) was not elevated. Bone marrow biopsy revealed B-precursor acute lymphoblastic leukemia. The patient failed two induction regimens but achieved remission after lymphoma-like chemotherapy. He continues to be in remission 7 years after double cord-blood transplantation.

Conclusions: The present case is used to explore the etiology and treatment of hypercalcemia associated with pediatric ALL, and to review the literature concerning the prognostic significance of multiple osteolytic lesions in a pediatric leukemia patient.


Acute lymphoblastic leukemia; Hypercalcemia; Osteolytic bone lesions

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