Non-Hodgkin's Lymphoma Complicated with Marked Hypercalcemia Caused by Parathyroid Hormone Related Protein, Presenting with Adams-Stokes Attack

摘要

A rare case of non-Hodgkin's lymphoma (NHL) complicated with marked hypercalcemia caused by parathyroid hormone related protein (PTHrP) and presenting with Adams-Stokes attack is reported. A 72-year-old woman was involved in a traffic accident, and was transferred to our hospital. Blood examination revealed marked hypercalcemia (5.3 mmol/l (21.3 mg/dl)). A diagnosis of NHL (B-cell lymphoma, clinical stage IVA) was made by the results of the bone marrow biopsy, CT features showing multiple masses, and the gallium scintigraphy showing strong accumulation. Because of high blood level of PTHrP, hypercalcemia was considered to be due to PTHrP as a mediator acting on calcium metabolism. Hypercalcemia complicated with malignancy has a risk resulting in a fatal outcome. In the cases of malignant lymphoma complicated with hypercalcemia, we should pay attention to PTHrP as a mediator.