{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:13:47Z","timestamp":1784783627398,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T00:00:00Z","timestamp":1669593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Hypercalcemia 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We 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\u2005mg\/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\u2005h after the application of bisphosphonates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hypercalcemia 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2022.1027421","type":"journal-article","created":{"date-parts":[[2022,11,21]],"date-time":"2022-11-21T04:54:44Z","timestamp":1669006484000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient\u2014a diagnostic and therapeutic approach: Case report"],"prefix":"10.3389","volume":"10","author":[{"given":"Carolina","family":"Bonilla Gonzalez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarha M.","family":"Vargas Mu\u00f1oz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda\u00a0Luisa","family":"Contreras Diaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Obando Belalcazar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila","family":"Uribe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,11,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1097\/MPH.0000000000000525","article-title":"Severe hypercalcemia in a child with acute lymphoblastic leukemia relapse: successful management with combination of calcitonin and bisphosphonate","volume":"38","author":"Tagiyev","year":"2016","journal-title":"J Pediatr Hematol Oncol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1007\/s00467-020-04603-6","article-title":"Hypercalcemia, hyperuricemia, and kidney dysfunction in a 35-month-old boy: answers","volume":"36","author":"Lin","year":"2021","journal-title":"Pediatr Nephrol"},{"key":"B3","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-28794-8_29","article-title":"Oncologic emergencies","volume-title":"Emergency department critical care","author":"Wacker","year":"2020"},{"key":"B4","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1515\/jpem-2013-0244","article-title":"Hypercalcemia and osteolytic lesions as presenting symptoms of acute lymphoblastic leukemia in childhood. The use of zoledronic acid and review of the literature","volume":"27","author":"Kolyva","year":"2014","journal-title":"J Pediatr Endocrinol Metab"},{"key":"B5","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1007\/s12098-013-1263-9","article-title":"Acute lymphoblastic leukemia mimicking metabolic bone disease","volume":"81","author":"Das","year":"2014","journal-title":"Indian J Pediatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"402","DOI":"10.12659\/AJCR.914303","article-title":"Acute lymphoblastic leukemia with malignant hypercalcemia: a case report","volume":"20","author":"Bota","year":"2019","journal-title":"Am J Case Rep"},{"key":"B7","first-page":"360","article-title":"Extramedullary manifestations in acute lymphoblastic leukemia in children: a systematic review and guideline-based approach of treatment","volume":"10","author":"Shahriari","year":"2020","journal-title":"Am J Blood Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"339","DOI":"10.2147\/CLEP.S137616","article-title":"Prevalence of hypercalcemia of malignancy among pediatric cancer patients in the UK clinical practice research datalink database","volume":"9","author":"Jick","year":"2017","journal-title":"Clin Epidemiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"99","DOI":"10.6065\/apem.2016.21.2.99","article-title":"Successful treatment of hypercalcemia with zoledronic acid in a 15-year-old boy with acute lymphoblastic leukemia","volume":"21","author":"Park","year":"2016","journal-title":"Ann Pediatr Endocrinol Metab"},{"key":"B10","year":""},{"key":"B11","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/S1132-8460(09)73229-5","article-title":"Hipercalcemia como urgencia m\u00e9dica","volume":"18","author":"Nuevo-Gonz\u00e1lez","year":"2009","journal-title":"Rev Esp Enfermedades Metab Oseas"},{"key":"B12","doi-asserted-by":"publisher","first-page":"377","DOI":"10.3322\/caac.21489","article-title":"Hypercalcemia and cancer: differential diagnosis and treatment","volume":"68","author":"Zagzag","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"B13","year":""},{"key":"B14","doi-asserted-by":"publisher","first-page":"483","DOI":"10.4103\/1947-2714.170600","article-title":"Hypercalcemia of malignancy: an update on pathogenesis and management","volume":"7","author":"Mirrakhimov","year":"2015","journal-title":"N Am J Med Sci"},{"key":"B15","first-page":"99","article-title":"El sistema RANK\/RANKL\/OPG y sus implicaciones cl\u00ednicas en la osteoporosis","volume":"11","author":"Esparza-Guerrero","year":"2016","journal-title":"El Resid"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.4158\/EP14308.CR","article-title":"Extreme hypercalcemia of malignancy in a pediatric patient: therapeutic considerations","volume":"1","author":"Fisher","year":"2015","journal-title":"AACE Clin Case Reports"},{"key":"B17","doi-asserted-by":"publisher","first-page":"402","DOI":"10.5935\/0103-507X.20150067","article-title":"Hipercalcemia grave como forma de apresenta\u00e7\u00e3o de leucemia linfobl\u00e1stica aguda em crian\u00e7as","volume":"27","author":"Martins","year":"2015","journal-title":"Rev Bras Ter Intensiva"},{"key":"B18","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1136\/archdischild-2011-301284","article-title":"Investigation and management of hypercalcemia in children","volume":"97","author":"Davies","year":"2012","journal-title":"Arch Dis Child"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.1027421\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T11:31:19Z","timestamp":1669635079000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.1027421\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,28]]},"references-count":18,"alternative-id":["10.3389\/fped.2022.1027421"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.1027421","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,28]]},"article-number":"1027421"}}