SHM Converge Scientific Abstract ePoster Gallery-Hypercalcemia as Presenting Sign of Diffuse Large B Cell Lymphoma

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This case describes a patient who presented with altered mental status, fatigue, generalized weakness, shortness of breath, constipation, anorexia, and significant weight loss over one month. Initial labs revealed severe hypercalcemia with a calcium level of 15.8 mg/dL. Workup showed low PTH, PTHrP, 25-hydroxyvitamin D, and TSH, with normal 1,25-dihydroxyvitamin D and mildly elevated kappa light chain, raising concern for multiple myeloma or hypercalcemia related to immobility.<br /><br />The patient was treated with IV fluids, calcitonin, and zoledronic acid. After three days, hemoglobin began to fall, and further testing showed normocytic anemia, elevated ferritin, low iron, elevated LDH and haptoglobin, and pancytopenia on peripheral smear without blasts or dysplasia. Because of concern for an underlying hematologic malignancy, a bone scan and then bone marrow biopsy were performed.<br /><br />The biopsy revealed multifocal and diffuse infiltration of the bone marrow by atypical B cells positive for CD20 and CD79a, confirming diffuse large B-cell lymphoma (DLBCL). In this case, hypercalcemia was the presenting sign of DLBCL, despite the absence of lymphadenopathy or masses on imaging. The case was unusual because the presentation was acute and primarily neurologic, with severe hypercalcemia as the key clue.<br /><br />The report emphasizes that although hypercalcemia is commonly caused by primary hyperparathyroidism or malignancy, it can rarely be the first sign of hematologic cancers such as DLBCL. Early recognition and more invasive evaluation may be necessary when hypercalcemia is severe and accompanied by weight loss or other concerning symptoms. The patient completed CHOP-R chemotherapy and is currently in remission.

Asset Subtitle

Purnima Sharma

Meta Tag

Author List Hemanshi Mistry, Karteek Chennupati, Prakash Thomas, Purnima Sharma, Revathy Subramany, Roberto Prieto

Category Clinical Vignettes

Concept Hypercalcemia

Concept Malignancy

Concept Diffuse Large B-Cell Lymphoma

Concept Parathyroid Hormone

Concept Parathyroid Hormone-related Protein

Distinguished Non-Finalist

Presenter Organization Texas Tech Transmountain El Paso

Presenting Author Purnima Sharma

Track Adult

Keywords

hypercalcemia

diffuse large B-cell lymphoma

DLBCL

bone marrow biopsy

altered mental status

pancytopenia

weight loss

CD20 positive

CHOP-R chemotherapy

hematologic malignancy

Hypercalcemia

Malignancy

Diffuse Large B-Cell Lymphoma

Parathyroid Hormone

Parathyroid Hormone-related Protein