Short report
Severe hypercalcaemia in B-cell lymphoma: combined effects of
PTH-rP, IL-6 and TNF
Anna Daroszewskaa, Roger C Bucknalla, Patrick Chub, William D Fraserc
a Royal
Liverpool University Hospital, Liverpool L7 8XP, UK
Rheumatic Diseases Unit, b Department of Haematology, c Department
of Clinical Chemistry, University of Liverpool, Duncan Building,
Liverpool L7 8XP, UK
Accepted 28
April 1999
Hypercalcaemia as the only manifestation of B-cell lymphoma is
seen very rarely. Its pathophysiology is heterogenous and not well
understood. We report a 73-year-old man who presented with severe
hypercalcaemia before any signs of malignancy became evident. He was
diagnosed with a B-cell lymphoma on bone marrow trephine biopsy. The
hypercalcaemia was associated with high plasma concentrations of
parathyroid-hormone-related protein, interleukin-6 and tumour necrosis
factor. Our patient had markedly increased osteoclast and osteoblast
activity as a result of synergistic effects between these factors, with
consequent severe hypercalcaemia. This is the first reported example of
such combined effects of these factors in humans.
Keywords: hypercalcaemia; lymphoma; parathyroid-hormone-related protein; tumour necrosis factor; interleukin-6
© 1999 by The Fellowship of Postgraduate Medicine
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