acute lymphoblastic leukemia without circulating blasts presenting as severe hypercalcemia

hypercalcemia complicating malignancy is a rare complication in pediatric age group. in this article, we present a case with acute lymphoblastic leukemia presenting as severe hypercalcemia. a 10 years old girl presented with an acute onset of fever, nausea, vomiting, loss of weight, costovertebral pain and frequency. she was admitted with a presumptive diagnosis of acute pyelonephritis. her examination showed mild hepatosplenomegaly. in laboratory studies she had sever hypercalcemia. despite the absence of circulating blast, bone marrow aspiration was diagnostic of acute lymphoblastic leukemia. the hypercalcemia was initially treated with intravenous hydration and furosemide but the serum calcium levels normalized only after the beginning of specific chemotherapy. hypercalcemia represents an emergency in children, and acute leukemia must be considered in differential diagnosis even when there are no circulating blasts.