Humoral hypercalcemia revealing a malignant non hodgkin lymphoma

Introduction. - Hypercalcemia is a rare complication of non-Hodgkin lymphoma. Usually, hypercalcernia occurs late in the disease course, except for high-grade lymphoma. Most often hypercalcernia is related to excessive level of circulating PTH-rP or sometimes, 1,25(OH)(2)D3. Concomitant high plasmatic concentration of PTH-rP and 1,25(OH)(2)D3 is uncommon. Exegesis. - We report the case of a 82-year-old man who presented with abdominal pain and weight loss, leading to the diagnosis of diffuse large-B-cell lymphoma (high-grade lymphoma) associated with symptomatic hypercalcemia (3.21 mmol/1). PTH-rP and 1,25(OH)(2)D3 plasmatic levels were high. Calcium concentration was normalized with glucocorticoids and sequential chemotherapy. Conclusion. - This case report confirms that hypercalcemia, as consequence of excessive plasmatic level of PTH-rP secreted by tumoral cells, can occur early in the course of high-grade lymphoma. Glucocorticoids and chemotherapy are the best treatment options. (c) 2007 Elsevier Masson SAS. Tons droits reserves.