ACUTE LYMPHOBLASTIC LEUKEMIA WITHOUT CIRCULATING BLASTS PRESENTING AS SEVERE HYPERCALCEMIA

Hypercalcemia complicating malignancy is a rare complication in pediatric age group. inthis article, we present a case with acute lymphoblastic leukemia presenting as severe hypercalcemia. a10 years old girl presented with an acute onset of fever, nausea, vomiting, loss of weight, costovertebralpain and frequency. she was admitted with a presumptive diagnosis of acute pyelonephritis. herexamination showed mild hepatosplenomegaly. in laboratory studies she had sever hypercalcemia.despite the absence of circulating blasts, bone marrow aspiration was diagnostic of acute lymphoblasticleukemia. the hypercalcemia was initially treated with intravenous hydration and furosemide but theserum calcium level normalized only after the beginning of specific chemotherapy. hypercalcemiarepresents an emergency in children, and acute leukemia must be considered in differential diagnosiseven when there are no circulating blasts.