Hypercalcemia and multiple osteolytic bone lesions: A rare presentation of acute lymphoblastic leukemia

Hypercalcemia and osteolytic bone lesions are rare initial presentation of adult Acute Lymphoblastic Leukemia (ALL). This presentation is mainly described in pediatric ALL and information about adult ALL-associated hypercalcemia is limited. We describe a 21 years old woman presented with acute kidney injury, hypercalcemia and osteolytic bone lesions who was later diagnosed to have pre-B ALL. After correction of hypercalcemia and acute kidney injury by intravenous fluid administration, calcitonin, corticosteroid and eventually hemodialysis, the patient was treated by induction chemotherapy followed by complete remission. Unfortunately, she refused hematopoietic stem cell transplantation and relapsed three months after the last cycle of induction chemotherapy and died. In conclusion, this is a rare case report of hypercalcemia and osteolytic bone lesions as an initial presentation of pre-B cell ALL at early adulthood which showed the aggressive behavior and early relapse. So further investigations are needed to establish the role of this initial presentation in the prognosis of patients with ALL.