Premium
Hypercalcaemia: an unusual presenting feature of childhood acute lymphoblastic leukaemia
Author(s) -
Rajagopal Revathi,
Lum Su Han,
Jalaludin Muhammad Yazid,
Krishnan Shekhar,
Abdullah Wan A.,
Ariffin Hany
Publication year - 2013
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12500
Subject(s) - medicine , bone pain , immunophenotyping , bone marrow , hypercalcaemia , lethargy , pathology , bone marrow examination , elevated alkaline phosphatase , complete blood count , gastroenterology , alkaline phosphatase , immunology , calcium , biochemistry , flow cytometry , enzyme , chemistry
A 3-year-old boy was referred for management of severe symptomatic hypercalcaemia. His parents reported increasing lower limb pain and weakness over the preceding 4 months. Examination indicated a bedbound, pale, irritable child with generalized bony tenderness and peripheral lymphadenopathy; there were no palpable abdominal masses. The serum calcium was 5 3 mmol/l; serum phosphate, alkaline phosphatase and intact parathormone (PTH) were normal. Skeletal radiographs showed striking osteopenia and osteolysis in the skull and all long bones (images). Blood counts showed anaemia (Hb 87 g/l) and mild thrombocytopenia (platelet count 134 9 10/l); peripheral blood microscopy was unremarkable. Bone marrow studies led to a diagnosis of B-cell precursor acute lymphoblastic leukaemia (CD34, CD10, CD19 and cytoplasmic l chain positive on immunophenotyping). Bone marrow karyotyping showed 46,XY. Molecular screening for ETV6RUNX1, TCF3-PBX1 and BCR-ABL1 oncogenes was negative.