Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient—a diagnostic and therapeutic approach: Case report
BackgroundHypercalcemia is a rare metabolic disorder in the pediatric population, with several differential diagnoses that resemble hematologic malignancies. In cases of severe hypercalcemia, therapeutic strategies other than hyperhydration, such as the use of bisphosphonates, have been described.Ca...
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| Format: | Article |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.1027421/full |
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| author | Carolina Bonilla Gonzalez Sarha M. Vargas Muñoz María Luisa Contreras Diaz Evelyn Obando Belalcazar Camila Uribe |
| author_facet | Carolina Bonilla Gonzalez Sarha M. Vargas Muñoz María Luisa Contreras Diaz Evelyn Obando Belalcazar Camila Uribe |
| author_sort | Carolina Bonilla Gonzalez |
| collection | DOAJ |
| description | BackgroundHypercalcemia is a rare metabolic disorder in the pediatric population, with several differential diagnoses that resemble hematologic malignancies. In cases of severe hypercalcemia, therapeutic strategies other than hyperhydration, such as the use of bisphosphonates, have been described.Case presentationWe present the case of a previously healthy 12-year-old boy who was admitted to the emergency department due to fatigue, hypo-responsiveness, and progressively worsening poor appetite for the previous 19 days. Initial laboratory tests revealed severe hypercalcemia (total calcium: 19 mg/dl), hyperphosphatemia, elevated creatinine, and hyperuricemia. Management with hyperhydration and xanthine oxidase inhibitor (allopurinol) was provided. The patient was transferred to the pediatric intensive care unit where treatment with furosemide, systemic corticosteroid, and zoledronic acid was started. Metabolic, infectious, renal, and endocrinological causes were excluded. Follow-up paraclinical studies showed a progressive hematologic involvement with heterogeneous hypochromic microcytic anemia, thrombocytopenia, and elevated lactic dehydrogenase. Bone marrow aspiration and biopsy were performed, which confirmed the diagnosis of B-precursor acute lymphoblastic leukemia. Hypercalcemia was resolved 72 h after the application of bisphosphonates.ConclusionHypercalcemia as an oncological metabolic emergency in the onset of acute lymphoblastic leukemia is uncommon in children. The use of intravenous bisphosphonates is an effective therapy in the early resolution of the condition. We present the case of a 12-year-old patient with malignant hypercalcemia who responded favorably to the use of a single dose of bisphosphonates. |
| first_indexed | 2024-04-12T05:01:06Z |
| format | Article |
| id | doaj.art-2b81b6617d744df5b9e7bc33edffdfce |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-12T05:01:06Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-2b81b6617d744df5b9e7bc33edffdfce2022-12-22T03:46:59ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-11-011010.3389/fped.2022.10274211027421Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient—a diagnostic and therapeutic approach: Case reportCarolina Bonilla Gonzalez0Sarha M. Vargas Muñoz1María Luisa Contreras Diaz2Evelyn Obando Belalcazar3Camila Uribe4Pediatric Intensive Care Unit, Department of Pediatrics, Fundación Santa Fe de Bogotá University Hospital, Bogotá, ColombiaDepartment of Pediatrics, Fundación Santa Fe de Bogotá, Bogotá, ColombiaPediatric Intensive Care Unit, Department of Pediatrics, Fundación Santa Fe de Bogotá University Hospital, Bogotá, ColombiaPediatric Intensive Care Unit, Department of Pediatrics, Fundación Santa Fe de Bogotá University Hospital, Bogotá, ColombiaDepartment of Pediatrics, Fundación Santa Fe de Bogotá University Hospital, Universidad de los Andes, Bogotá, ColombiaBackgroundHypercalcemia is a rare metabolic disorder in the pediatric population, with several differential diagnoses that resemble hematologic malignancies. In cases of severe hypercalcemia, therapeutic strategies other than hyperhydration, such as the use of bisphosphonates, have been described.Case presentationWe present the case of a previously healthy 12-year-old boy who was admitted to the emergency department due to fatigue, hypo-responsiveness, and progressively worsening poor appetite for the previous 19 days. Initial laboratory tests revealed severe hypercalcemia (total calcium: 19 mg/dl), hyperphosphatemia, elevated creatinine, and hyperuricemia. Management with hyperhydration and xanthine oxidase inhibitor (allopurinol) was provided. The patient was transferred to the pediatric intensive care unit where treatment with furosemide, systemic corticosteroid, and zoledronic acid was started. Metabolic, infectious, renal, and endocrinological causes were excluded. Follow-up paraclinical studies showed a progressive hematologic involvement with heterogeneous hypochromic microcytic anemia, thrombocytopenia, and elevated lactic dehydrogenase. Bone marrow aspiration and biopsy were performed, which confirmed the diagnosis of B-precursor acute lymphoblastic leukemia. Hypercalcemia was resolved 72 h after the application of bisphosphonates.ConclusionHypercalcemia as an oncological metabolic emergency in the onset of acute lymphoblastic leukemia is uncommon in children. The use of intravenous bisphosphonates is an effective therapy in the early resolution of the condition. We present the case of a 12-year-old patient with malignant hypercalcemia who responded favorably to the use of a single dose of bisphosphonates.https://www.frontiersin.org/articles/10.3389/fped.2022.1027421/fullchildhypercalcemiahematologic neoplasmsleukemiazoledronic acid |
| spellingShingle | Carolina Bonilla Gonzalez Sarha M. Vargas Muñoz María Luisa Contreras Diaz Evelyn Obando Belalcazar Camila Uribe Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient—a diagnostic and therapeutic approach: Case report Frontiers in Pediatrics child hypercalcemia hematologic neoplasms leukemia zoledronic acid |
| title | Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient—a diagnostic and therapeutic approach: Case report |
| title_full | Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient—a diagnostic and therapeutic approach: Case report |
| title_fullStr | Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient—a diagnostic and therapeutic approach: Case report |
| title_full_unstemmed | Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient—a diagnostic and therapeutic approach: Case report |
| title_short | Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient—a diagnostic and therapeutic approach: Case report |
| title_sort | malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient a diagnostic and therapeutic approach case report |
| topic | child hypercalcemia hematologic neoplasms leukemia zoledronic acid |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.1027421/full |
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