{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T12:56:59Z","timestamp":1782910619730,"version":"3.54.5"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T00:00:00Z","timestamp":1654732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004829","name":"Department of Science and Technology of Sichuan Province","doi-asserted-by":"publisher","award":["21ZDYF1743"],"award-info":[{"award-number":["21ZDYF1743"]}],"id":[{"id":"10.13039\/501100004829","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Acute lymphoblastic leukemia (ALL) presenting with hypercalcemia and osteolytic lesions is rare and unusual in childhood. We report a case of a 13-year-old boy with ALL who presented with intermittent fever, nausea, vomiting, and increasing lower limb pain. Skeletal X-rays and CT scan showed severe osteolytic lesions of the skull and extremities. Physical examination revealed multiple inguinal lymph nodes. Laboratory tests demonstrated severe hypercalcemia (Ca &amp;gt; 3.49 mmol\/L), decreased parathyroid hormone (PTH), and vitamin D level. Despite a normal complete blood count and the absence of circulating blasts, bone marrow biopsy revealed B-precursor ALL. Hypercalcemia was initially treated with intravenous isotonic sodium chloride and furosemide but the serum calcium level was not normalized. It was successfully managed with calcitonin and pamidronate afterward. Later, the child responded well to chemotherapy and continued with consolidation treatment. The clinical condition was stable, and the bone marrow revealed complete remission. This case indicated that hypercalcemia alone or combined with osteolytic lesions can be the only presenting symptom of ALL in children. Diagnostic errors may occur especially when combined with the absence of circulating blasts in the peripheral blood smear. Bone marrow aspiration should be considered to confirm the diagnosis.<\/jats:p>","DOI":"10.3389\/fped.2022.923297","type":"journal-article","created":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T06:17:28Z","timestamp":1654755448000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Hypercalcemia and Osteolytic Lesions as Presenting Symptoms of Acute Lymphoblastic Leukemia in Children: Case Report and Literature Review"],"prefix":"10.3389","volume":"10","author":[{"given":"Min","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxi","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/865979","article-title":"Characterization of pediatric acute lymphoblastic leukemia survival patterns by age at diagnosis.","volume":"2014","author":"Hossain","year":"2014","journal-title":"J Cancer Epidemiol."},{"key":"B2","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1002\/1097-0142(19930701)72:1<256::AID-CNCR2820720145>3.0.CO;2-D","article-title":"Hypercalcemia complicating childhood malignancies.","volume":"72","author":"McKay","year":"1993","journal-title":"Cancer."},{"key":"B3","doi-asserted-by":"crossref","first-page":"402","DOI":"10.5935\/0103-507X.20150067","article-title":"Severe hypercalcemia as a form of acute lymphoblastic leukemia presentation in children.","volume":"27","author":"Martins","year":"2015","journal-title":"Rev Bras Ter Intensiva."},{"key":"B4","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1002\/pbc.20357","article-title":"Acute lymphocytic leukemia in adolescence with multiple osteolytic lesions and hypercalcemia mediated by lymphoblast-producing parathyroid hormone-related peptide: a case report and review of the literature.","volume":"45","author":"Shimonodan","year":"2005","journal-title":"Pediatr Blood Cancer."},{"key":"B5","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1038\/sj.leu.2404496","article-title":"Hypercalcemia in childhood acute lymphoblastic leukemia: frequent implication of parathyroid hormone-related peptide and E2A-HLF from translocation 17;19.","volume":"21","author":"Inukai","year":"2007","journal-title":"Leukemia."},{"key":"B6","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":"B7","first-page":"176","article-title":"Hypercalcemia: pathogenesis, clinical manifestations, differential diagnosis, and management.","author":"Shane","year":"2006","journal-title":"Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism."},{"key":"B8","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1097\/MPH.0b013e3181a1c12b","article-title":"Hypercalcemia in acute lymphoblastic leukemia: an overview.","volume":"31","author":"Trehan","year":"2009","journal-title":"J Pediatr Hematol Oncol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.2147\/TCRM.S83681","article-title":"Hypercalcemia of malignancy and new treatment options.","volume":"11","author":"Sternlicht","year":"2015","journal-title":"Ther Clin Risk Manag."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2017.00233","article-title":"Malignancy-induced hypercalcemia-diagnostic challenges.","volume":"5","author":"Hoyoux","year":"2017","journal-title":"Front Pediatr."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2464","DOI":"10.1200\/JCO.2007.12.1269","article-title":"American society of clinical oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma.","volume":"25","author":"Kyle","year":"2007","journal-title":"J Clin Oncol."},{"key":"B12","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":"B13","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1111\/jpc.13768","article-title":"Consensus guidelines on the use of bisphosphonate therapy in children and adolescents.","volume":"54","author":"Simm","year":"2018","journal-title":"J Paediatr Child Health."},{"key":"B14","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.4103\/0973-1482.187240","article-title":"Severe hypercalcemia: a rare and unusual presentation of acute lymphoblastic leukemia.","volume":"14","author":"Dhivyasree","year":"2018","journal-title":"J Cancer Res Ther."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.923297\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T06:17:35Z","timestamp":1654755455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.923297\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,9]]},"references-count":14,"alternative-id":["10.3389\/fped.2022.923297"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.923297","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,9]]},"article-number":"923297"}}