Letter to the Editor

Burkitt Lymphoma Presenting with Hypercalcemic Emergency

Authors: Nasser Mikhail, MD, MSc, Shahriar Pirouz, MD, Hena Theile Borneo, MD, Alice Kim MD, Daniel Kim, MD, Nancy Feldman, MD, Jeffrey Miller, MD, Louis Lovato, MD, Emil Heinze, MD, Soma Wali, MD, Dennis Cope, MD

Abstract

To the Editor:


Burkitt lymphoma is an aggressive type of non-Hodgkin lymphoma occurring in endemic, sporadic, and immunodeficient forms.1 Hypercalcemia is a rare complication of Burkitt lymphoma, and its underlying mechanisms are ill defined. A 40-year-old human immunodeficiency virus-positive woman presented with a progressive abdominal painful swelling, nausea, vomiting, and dehydration. Her blood chemistry revealed severe hypercalcemia with a plasma calcium (corrected for plasma albumin level) of 16.4 mg/dL (n = 8.9–10.3), phosphorus 2.0 mg/dL (n = 2.4–4.7), lipase 369 U/L (n = 22–51), calcitriol (1.25-dihydroxyvitamin D3) 31 pg/mL (n = 15–60), undetectable plasma levels of intact parathyroid hormone (PTH), and parathyroid-related peptide (PTH-rp). She had normal renal function. Abdominal computed tomography revealed a 13.3 × 11.8 cm mass anterior to the left kidney. A biopsy of the mass confirmed the diagnosis of Burkitt lymphoma. A skeletal bone scan showed tiny metastases in the skull and questionable metastases in the fourth vertebral body. The patient was treated with aggressive hydration with normal saline, calcitonin, hydrocortisone, and zoledronic acid in addition to chemotherapy. Corrected plasma calcium levels dropped to 14.7 mg/dL after 24 hours, and normalized after 48 hours, reaching a corrected calcium plasma level of 10.0 mg/dL. Her abdominal pain was mainly attributed to acute pancreatitis, and markedly improved after correcting the hypercalcemia.

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References

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