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Background <p>Hypercalcemia is a common occurrence in patients with malignancy. Multiple mechanisms can contribute to the development of hypercalcemia associated with malignancy with specific mechanisms often linked to particular types of cancer. Parathyroid hormone-related protein (PTHrP) and excessive production of 1,25-dihydroxyvitamin D can independently and rarely concurrently, lead to hypercalcemia in patients with various malignancies. Although rare, diffuse large B cell lymphoma (DLBCL) is associated with hypercalcaemia.</p> Case Presentation <p>We report a 73-year-old male patient who presented with B symptoms and generalized lymphadenopathy. Investigations revealed pancytopenia, hypercalcaemia with low parathyroid hormone levels, normal parathyroid-related peptide and 25-hydroxyvitamin D levels, but high 1,25-dihydroxyvitamin D levels. Inguinal lymph node excision biopsy confirmed DLBCL germ cell type.</p> Conclusion <p>This case report emphasizes a rare, but significant presentation of diffuse large B-cell lymphoma (DLBCL) due to elevated activated vitamin D levels. It is essential to consider malignancies like DLBCL in the differential diagnosis of undifferentiated hypercalcemia in elderly patients. Additionally, the evaluation should encompass extrarenal causes of hypercalcemia, including the production of PTHrP and levels of calcitriol.</p>

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Hypercalcaemia Due to Elevated Vitamin D Levels: A Rare Presentation of a Rare Complication of Diffuse Large B-Cell Lymphoma in an Older Adult—A Case Report

  • 期刊论文

  • 发表日期：

    2025年9月9日

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  • Gayashani Jayasinghe,
  • Udara Perera,
  • Uditha Hettiarachchi,
  • Shehan Silva

摘要

Background

Hypercalcemia is a common occurrence in patients with malignancy. Multiple mechanisms can contribute to the development of hypercalcemia associated with malignancy with specific mechanisms often linked to particular types of cancer. Parathyroid hormone-related protein (PTHrP) and excessive production of 1,25-dihydroxyvitamin D can independently and rarely concurrently, lead to hypercalcemia in patients with various malignancies. Although rare, diffuse large B cell lymphoma (DLBCL) is associated with hypercalcaemia.

Case Presentation

We report a 73-year-old male patient who presented with B symptoms and generalized lymphadenopathy. Investigations revealed pancytopenia, hypercalcaemia with low parathyroid hormone levels, normal parathyroid-related peptide and 25-hydroxyvitamin D levels, but high 1,25-dihydroxyvitamin D levels. Inguinal lymph node excision biopsy confirmed DLBCL germ cell type.

Conclusion

This case report emphasizes a rare, but significant presentation of diffuse large B-cell lymphoma (DLBCL) due to elevated activated vitamin D levels. It is essential to consider malignancies like DLBCL in the differential diagnosis of undifferentiated hypercalcemia in elderly patients. Additionally, the evaluation should encompass extrarenal causes of hypercalcemia, including the production of PTHrP and levels of calcitriol.