An Uncommon Presentation of Hypercalcemia in Chronic Lymphocytic Leukemia
Hypercalcemia is a common paraneoplastic syndrome in both solid and hematologic malignancies. There are three mechanisms involving in hypercalcemia. Firstly, the cancer increases the resorption of bone minerals resulting in releasing calcium and phosphate into plasma. Secondly, parathyroid hormone-related peptide (PTHrP) increases a reabsorption of calcium and excretion of phosphate at kidneys. Finally, calcitriol (1,25 dihydroxy vitamin D) induces vitamin D absorption in small bowel. Multiple myeloma or T-cell leukemia-lymphoma are usually presented with a symptomatic hypercalcemia. However, chronic lymphocytic leukemia (CLL) is uncommonly associated with hypercalcemia. Hypercalcemia occurring in CLL patients mostly indicates a relapsed or a refractory disease. In addition, it may imply an advanced stage as well as the transformation of disease to Richter’s syndrome. This report presents an 81-year-old woman diagnosed with CLL, Rai stage III. She developed symptomatic hypercalcemia with an osteolytic lesion at left iliac wing together with an increased absolute lymphocyte count.
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