Persistent Hypercalcemia Leading to Acute Pancreatitis in a Patient with Relapsed Myeloma and Renal Failure

This article is also accessible online at: http://BioMedNet.com/karger Dear Sir, Renal failure and disorders of calcium metabolism are encountered frequently during the natural course of plasma cell neoplasms [1]. Hypercalcemia itself and various confounding factors often induce or complicate renal dysfunction in multiple myeloma (MM), and prompt management is closely associated with favorable prognosis and survival [2, 3]. After a plateau duration of 8.5 months, a 57-year-old male patient, having the diagnosis of stage 3-A IgG-kappa-type MM, was readmitted to our clinic with complaints of agitation and cramp-like abdominal pain extending to the back. His past history was unremarkable for consumption of alcohol or any drug. Physical examination disclosed epigastric tenderness with hypoactive bowel sounds. Urinalysis was normal except for trace proteinuria. Blood chemistry studies revealed increased serum levels of calcium (3.4 mmol/l), amylase (21.3 Ìkat/l) and lipase (9.0 Ìkat/l) with disturbed renal function (BUN: 26.8 mmol/l; creatinine: 318.2 Ìmol/l). Liver enzymes were normal and hyperlipidemia was not present. Marked anemia (Hb: 3.5 mmol/l) and thrombocytopenia (platelet count: 70 ! 109/l) were observed. Bone marrow aspiration disclosed diffuse atypical plasma cell infiltration of the marrow. Computed tomography of the abdomen revealed disturbed pancreatic contour, linear collection around the pancreatic tail and edema of peripancreatic tissue con-