Severe resistant hypocalcemia in multiple myeloma after zoledronic acid administration: a case reportReport as inadecuate

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Journal of Medical Case Reports

, 8:353

First Online: 23 October 2014Received: 07 March 2014Accepted: 26 August 2014DOI: 10.1186-1752-1947-8-353

Cite this article as: Noriega Aldave, A.P. & Jaiswal, S. J Med Case Reports 2014 8: 353. doi:10.1186-1752-1947-8-353


IntroductionHypercalcemia 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 presentationA 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.

ConclusionsUnderlying 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.

KeywordsHypocalcemia Multiple myeloma Vitamin D deficiency Zoledronic acid AbbreviationsMMMultiple myeloma

ZAZoledronic acid.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-8-353 contains supplementary material, which is available to authorized users.

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Author: Adrian P Noriega Aldave - Shikha Jaiswal


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