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Missed diagnosis of lymphoma presenting with humoral hypercalcemia of malignancy due to cessation of oncological workup after negative computed tomography scans
  1. Ellery Altshuler1,
  2. Mahmoud Aryan2,
  3. William King1 and
  4. Rolando Otero3
  1. 1Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  2. 2Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
  3. 3University of Florida College of Medicine, Gainesville, Florida, USA
  1. Correspondence to Dr Ellery Altshuler; ElleryAltshuler{at}


Malignancy is the most common cause of hypercalcemia among hospitalised patients and is frequently caused by elevations in parathyroid hormone-related peptide (PTHrP). The most common PTHrP-producing cancers are carcinomas of the head, neck and lung. Hypercalcemia can be the presenting sign of cancer and, in these cases, solid tumours are usually discovered on CT scan. In rare cases, lymphoma may also present with hypercalcemia. CT scan is less sensitive for lymphoma than for most solid tumours and the diagnosis may be missed. We present the case of a 69-year-old woman who presented with hypercalcemia in the setting of severe weight loss and elevated PTHrP. Oncological workup was stopped after unrevealing CT scans and an underlying lymphoma was missed. Our case emphasises the need for a comprehensive oncological workup for patients with unexplained hypercalcemia and elevated PTHrP, even when CT scans are unrevealing.

  • calcium and bone
  • oncology

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  • Contributors EA conceived of the idea for the case reports and was primarily responsible for writing the manuscript. EA also helped with background research. MA assisted with writing the manuscript and provided subject matter expertise. RO and WK helped with background research and assisted in the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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