{"title":"A Case of Intravascular Large B-Cell Lymphoma Complicated by Hypercalcaemia.","authors":"Masahiro Yabe, Takashi Abe, Saori Yamaga, Seiga Ozaki, Katsuhiro Tomiyama, Hideki Hashidate","doi":"10.12890/2025_005406","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Hypercalcaemia in intravascular large B-cell lymphoma (IVLBCL) is extremely rare, occurring more often in other non-Hodgkin's lymphomas (NHL).</p><p><strong>Case description: </strong>A 68-year-old man was admitted with a fever of unknown origin, mild disturbance of consciousness and respiratory failure. Laboratory findings showed hypercalcaemia with elevated parathyroid hormone-related protein (PTHrP) and decreased intact parathyroid hormone and 1,25-dihydroxyvitamin D. The patient was diagnosed with IVLBCL via random skin biopsy. Chemotherapy resulted in complete remission and normalised PTHrP levels.</p><p><strong>Conclusion: </strong>More than half of all cases of hypercalcaemia in NHL are not associated with PTHrP or 1,25-dihydroxyvitamin D, and the cause of the hypercalcaemia is unknown. However, PTHrP levels are elevated in most cases of IVLBCL with hypercalcaemia, which may present as humoral hypercalcaemia of malignancy.</p><p><strong>Learning points: </strong>Intravascular large B-cell lymphoma, a rare, clinically aggressive type of B-cell non-Hodgkin's lymphoma, is prone to central nervous system disturbances, including altered consciousness.Hypercalcaemia, which causes impaired consciousness, is extremely rare in intravascular large B-cell lymphoma, occurring more often in other non-Hodgkin's lymphomas.Parathyroid hormone-related protein is elevated in most cases of intravascular large B-cell lymphoma with hypercalcaemia, which may present as humoral hypercalcaemia of malignancy.</p>","PeriodicalId":11908,"journal":{"name":"European journal of case reports in internal medicine","volume":"12 5","pages":"005406"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061217/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European journal of case reports in internal medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.12890/2025_005406","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Hypercalcaemia in intravascular large B-cell lymphoma (IVLBCL) is extremely rare, occurring more often in other non-Hodgkin's lymphomas (NHL).
Case description: A 68-year-old man was admitted with a fever of unknown origin, mild disturbance of consciousness and respiratory failure. Laboratory findings showed hypercalcaemia with elevated parathyroid hormone-related protein (PTHrP) and decreased intact parathyroid hormone and 1,25-dihydroxyvitamin D. The patient was diagnosed with IVLBCL via random skin biopsy. Chemotherapy resulted in complete remission and normalised PTHrP levels.
Conclusion: More than half of all cases of hypercalcaemia in NHL are not associated with PTHrP or 1,25-dihydroxyvitamin D, and the cause of the hypercalcaemia is unknown. However, PTHrP levels are elevated in most cases of IVLBCL with hypercalcaemia, which may present as humoral hypercalcaemia of malignancy.
Learning points: Intravascular large B-cell lymphoma, a rare, clinically aggressive type of B-cell non-Hodgkin's lymphoma, is prone to central nervous system disturbances, including altered consciousness.Hypercalcaemia, which causes impaired consciousness, is extremely rare in intravascular large B-cell lymphoma, occurring more often in other non-Hodgkin's lymphomas.Parathyroid hormone-related protein is elevated in most cases of intravascular large B-cell lymphoma with hypercalcaemia, which may present as humoral hypercalcaemia of malignancy.
期刊介绍：
The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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