SHM Converge Scientific Abstract ePoster Gallery-When Calcium Is Being Difficult: A Radiotherapy Induced T-Cell Lymphoma

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This case describes an 83-year-old woman with a history of right breast cancer treated with lumpectomy and chemo-radiation 12 years earlier who presented with 5 days of weakness and confusion. She was found to have severe hypercalcemia (calcium 17.2 mg/dL), leukocytosis, low vitamin D, and elevated parathyroid hormone–related peptide. She was initially treated for presumed malignancy-related hypercalcemia with aggressive IV fluids, calcitonin, cinacalcet, prednisone, denosumab, and later zoledronic acid, but her calcium remained difficult to control.<br /><br />A pan-CT scan showed diffuse lymphadenopathy, and lymph node biopsy confirmed CD30-negative T-cell lymphoma. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone was started, after which her calcium level dropped dramatically and she improved enough to be discharged for outpatient treatment.<br /><br />The report highlights that T-cell lymphomas are aggressive blood cancers that can rarely develop after prior ionizing radiation exposure. It also emphasizes that hypercalcemia is an uncommon but serious manifestation of lymphoma and often indicates advanced disease. Severe hypercalcemia can cause neuropsychiatric, renal, and gastrointestinal complications and requires prompt treatment.<br /><br />Standard management of malignancy-associated hypercalcemia includes high-rate isotonic IV hydration, calcitonin for rapid short-term control, and bisphosphonates such as zoledronic acid; denosumab is useful in bisphosphonate-resistant cases or renal dysfunction. However, definitive control depends on treating the underlying malignancy.

Asset Subtitle

Farhan Khalid

Meta Tag

Author List Adhithya Rajamohan, Farhan Khalid, Hardikkumar Bhanderi, Muhammad Tayyeb, Patrick Lee

Category Clinical Vignettes

Concept T-Cell Lymphoma

Concept Hypercalcemia of Malignancy

Concept Intravenous Hydration

Concept Bisphosphonate

Concept Chemotherapy

Distinguished Non-Finalist

Presenter Organization Monmouth Medical Center

Presenting Author Farhan Khalid

Track Adult

Keywords

hypercalcemia

T-cell lymphoma

malignancy-associated hypercalcemia

parathyroid hormone-related peptide

lymphadenopathy

radiation-induced cancer

zoledronic acid

denosumab

calcitonin

chemotherapy

T-Cell Lymphoma

Hypercalcemia of Malignancy

Intravenous Hydration

Bisphosphonate

Chemotherapy