SHM Converge Scientific Abstract ePoster Gallery-When Fatigue Speaks! A Case of Fatal Hypercalcemia Revealing Adult T-Cell Leukemia/Lymphoma

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This case report describes a 68-year-old Jamaican woman who presented with one week of generalized fatigue, dizziness, and constipation. On exam she was tachycardic and lethargic. Laboratory testing revealed severe hypercalcemia (17.3 mg/dL), marked lymphocytosis (77,000), and very elevated LDH (7,000 U/L). CT imaging showed bilateral axillary lymphadenopathy. Peripheral flow cytometry demonstrated a predominance of atypical T cells, and she tested positive for HTLV-1, leading to a diagnosis of leukemic adult T-cell leukemia/lymphoma (ATLL) complicated by tumor lysis syndrome (TLS) and hemophagocytic lymphohistiocytosis (HLH).<br /><br />Her hospital course was complicated and rapidly progressive. TLS initially improved with supportive care, but she later developed severe hyperkalemia, metabolic acidosis, and acute kidney injury requiring dialysis. After stabilization, multi-agent chemotherapy was started for ATLL. Although she initially improved, she then suffered a non-ST elevation myocardial infarction and ultimately died from multiorgan failure.<br /><br />The report highlights the aggressive nature of acute leukemic ATLL, especially in patients with HTLV-1 infection, who often present with advanced disease and poor outcomes. The authors emphasize that treatment options remain limited, there is no definitive therapy to prevent HTLV-1 replication in asymptomatic carriers, and further research is needed to improve prognosis.

Asset Subtitle

Henok Regassa

Meta Tag

Author List Asli S. Sucu, Henok Regassa

Category Clinical Vignettes

Concept Adult T-Cell Leukemia/Lymphoma

Concept HTLV-1

Concept Hypercalcemia

Concept Clinical Presentation

Concept Laboratory Findings

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center

Presenting Author Henok Regassa

Track Adult

Keywords

adult T-cell leukemia/lymphoma

HTLV-1

tumor lysis syndrome

hemophagocytic lymphohistiocytosis

hypercalcemia

lymphocytosis

axillary lymphadenopathy

dialysis

chemotherapy

multiorgan failure

Adult T-Cell Leukemia/Lymphoma

HTLV-1

Hypercalcemia

Clinical Presentation

Laboratory Findings