Severe resistant hypocalcemia in multiple myeloma after zoledronic acid administration: a case report

Journal of Medical Case Reports

Shikha Jaiswal²  Adrian P Noriega Aldave¹ 

[1] UAB Health Center Montgomery, 2055 East South Boulevard, Suite 202, Montgomery, AL 36116, USA;East South Boulevard, Suite 202, Montgomery, AL 36116, USA

关键词: Zoledronic acid;    Vitamin D deficiency;    Multiple myeloma;    Hypocalcemia;   

Others  :  1181000
DOI  :  10.1186/1752-1947-8-353

 received in 2014-03-07, accepted in 2014-08-26,  发布年份 2014

【 摘 要 】

Introduction

Hypercalcemia is one of the most common metabolic abnormalities encountered in any form of malignancy. Hypocalcemia, however, is a rare manifestation, especially in cancers with bone involvement. Here we present a case of hypocalcemia in a patient with multiple myeloma that was refractory to treatment.

Case presentation

A 73-year-old African American woman recently diagnosed with multiple myeloma, presented with a 2-day history of fever, vomiting and hypocalcemia. Ten days prior to admission she received zoledronic acid, Velcade^® (bortezomib), Revlimid^® (lenalidomide) and dexamethasone. Treatment was started with intravenous antibiotics and calcium gluconate boluses. After 24 hours of treatment her calcium level became undetectable (<5mg/dL). Continuous intravenous calcium gluconate infusions in addition to boluses were started. She remained persistently hypocalcemic and eventually developed tonic–clonic seizures. Vitamin D levels were found to be low and intravenous paricalcitol was initiated, which improved her calcium level.

Conclusions

Underlying vitamin D deficiency can precipitate severe hypocalcemia in patients with multiple myeloma receiving bisphosphonates. This warrants baseline screening for vitamin D deficiency in these patients.

【 授权许可】

   
2014 Noriega Aldave and Jaiswal; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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