{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T12:40:11Z","timestamp":1745757611357,"version":"3.40.4"},"reference-count":7,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,2,1]]},"abstract":"<jats:p>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\u2019s 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.<\/jats:p>","DOI":"10.1136\/bcr-2014-208118","type":"journal-article","created":{"date-parts":[[2015,2,26]],"date-time":"2015-02-26T09:25:42Z","timestamp":1424942742000},"page":"bcr2014208118","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Pathological fractures in a patient with chronic lymphatic leucaemia without disease progression"],"prefix":"10.1136","volume":"2015","author":[{"given":"Jasper C M","family":"Langenberg","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willem-Maarten","family":"Bosman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jephta van den","family":"Bremer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ewan D","family":"Ritchie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,2,25]]},"reference":[{"key":"2025042705270813000_2015.feb25_1.bcr2014208118.1","doi-asserted-by":"crossref","first-page":"789","DOI":"10.3109\/10428190109099341","article-title":"Richter's syndrome following cladribine therapy for chronic lymphocytic leukemia first manifested at pathologic fracture of the femur","volume":"42","author":"Robak","year":"2010","journal-title":"Leuk Lymphoma"},{"key":"2025042705270813000_2015.feb25_1.bcr2014208118.2","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1182\/blood.V52.3.532.532","article-title":"Chronic lymphocytic leukemia (CLL) terminating in multiple myeloma: report of two cases","volume":"52","author":"Kough","year":"1978","journal-title":"Blood"},{"key":"2025042705270813000_2015.feb25_1.bcr2014208118.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1834-7819.1997.tb00091.x"},{"key":"2025042705270813000_2015.feb25_1.bcr2014208118.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2010.08541.x"},{"key":"2025042705270813000_2015.feb25_1.bcr2014208118.5","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1937.00170220007001"},{"key":"2025042705270813000_2015.feb25_1.bcr2014208118.6","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19851115)56:10<2508::AID-CNCR2820561031>3.0.CO;2-W"},{"key":"2025042705270813000_2015.feb25_1.bcr2014208118.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.281.6248.1107"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2014-208118","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T12:27:19Z","timestamp":1745756839000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2014-208118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2,25]]},"references-count":7,"alternative-id":["10.1136\/bcr-2014-208118"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2014-208118","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2015,2,25]]}}}