Primary multifocal lymphoma of bone presenting as hypercalcemic crisis: Report of a rare manifestation of extranodal lymphoma

Primary non-Hodgkin's lymphoma of bone is uncommon and usually manifests cl inically as localized bone pain. Here we report a woman who presented with hypercalcemic crisis and extensive investigation revealed a primary multifo cal lymphoma of bone. The course of the disease was very aggressive and des pite intensive supportive care and urgent chemotherapy the patient died wit hin 1 month. Since her blood PTH and calcitriol levels were suppressed and her parathyroid-hormone-related peptide (PTHrp) was mildly elevated, we bel ieve that release of cytokines combined with PTHrp, as well as extensive os teolytic lesions, were the causes of the hypercalcemia. This is an unusual presenting symptom of lymphomas and to the best of our knowledge severe sym ptomatic hypercalcemia and crisis has never been reported in primary lympho ma of bone before.