Severe hypercalcemia as a harbinger of acute lymphoblastic leukemia.

CASE: An 8-year-old girl presented to the emergency department with a history of nausea, vomiting, abdominal pain, tiredness, and weight loss of 18 lb over 3 weeks. The only significant examination finding was moderate dehydration. She was found to have severe hypercalcemia (serum calcium, 20 mg/dL). The complete blood count was normal. She was treated successfully for hypercalcemia with hyperhydration, furosemide, calcitonin, and pamidronate. A few days later, she developed pancytopenia when her bone marrow biopsy specimen established the diagnosis of acute lymphoblastic leukemia.

CONCLUSIONS

Hypercalcemia presents with nonspecific symptoms of nausea, vomiting, pain in the abdomen, constipation, and tiredness. It can be a harbinger of acute lymphoblastic leukemia. Normal complete blood cell count at presentation does not exclude the diagnosis of leukemia.