OBJECTIVE: Adult T-cell leukemia/lymphoma (ATL) is known for its aggressive behavior, frequently presenting with hypercalcemia. ATL tumor cells uniquely secrete parathyroid hormone-related protein, viral peptides, and inflammatory cytokines, inducing a state of high bone turnover and activation of the receptor activator of nuclear factor kappa-B signaling pathway resulting in hypercalcemia. METHODS: A 54-year-old woman diagnosed with ATL presented with severe hypercalcemia refractory to bisphosphonate therapy. Treatment with denosumab was followed by protracted hypocalcemia and hypophosphatemia lasting approximately 5 months. RESULTS: Hypercalcemia due to acute ATL was responsive in this case to denosumab therapy. CONCLUSION: Clinicians should be aware of the possibility of protracted hypocalcemia in patients with ATL exposed to denosumab therapy.
OBJECTIVE: Adult T-cell leukemia/lymphoma (ATL) is known for its aggressive behavior, frequently presenting with hypercalcemia. ATL tumor cells uniquely secrete parathyroid hormone-related protein, viral peptides, and inflammatory cytokines, inducing a state of high bone turnover and activation of the receptor activator of nuclear factor kappa-B signaling pathway resulting in hypercalcemia. METHODS: A 54-year-old woman diagnosed with ATL presented with severe hypercalcemia refractory to bisphosphonate therapy. Treatment with denosumab was followed by protracted hypocalcemia and hypophosphatemia lasting approximately 5 months. RESULTS: Hypercalcemia due to acute ATL was responsive in this case to denosumab therapy. CONCLUSION: Clinicians should be aware of the possibility of protracted hypocalcemia in patients with ATL exposed to denosumab therapy.
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