Atypical Presentation of Acute Lymphoblastic Leukemia type B in a Young Adult without expression in peripheral blood

Abstract

B acute lymphoblastic leukemia (B-ALL) is a pathology with bimodal distribution with a first peak in patients under 20 years of age and the second after 45 years of age (1). It represents 75-80% of acute leukemias in pediatrics, mainly with spinal cord involvement, although it may present extramedullary involvement. The presentation of ALL B without the presence of blasts in peripheral blood has an incidence of 15% in adolescents and young adult (AYA) (2), and extramedullary involvement at diagnosis with osteolytic bone lesions and hypercalcemia is rare, so it can delay your diagnosis. The case of a 38-year-old patient who presented as the only manifestation of ALL B at first, osteolytic lesions with compromise of the skull, axial skeleton and both hips is presented associated with hypercalcemia and acute renal failure in the absence of B lymphoid blasts in peripheral blood.