case_images: PMC5266834_01
case_images: Evolution of hypercalcemia in relation to medical therapies instituted. Please note that majority of ionized calcium data from first admission are unavailable. Also, ionized calcium levels are unavailable on 1/5/2016 when denosumab was administered.
case_images: CRIE2017-2608392.001.jpg
case_images: PMC5266834_01_CRIE2017-2608392.001.jpg
case_images: fig1
case_images: Over the ensuing 3 days, iCa slowly increased to 1.46 mg/dL and required administration of zoledronate 4 mg resulting in normalization of iCa between 1 and 1.1 mg/dL for the rest of the admission (Figure 1). During outpatient follow-up and 5 days after discharge, a rapid rebound in hypercalcemia occurred with Calc of 12.6 mg/dL and iCa of 1.46 mg/dL, requiring administration of denosumab 120 mg which decreased iCa to 1.25 mg/dL (Figure 1). Although iCa level decreased to 1.3-1.4 mg/dL within 2 days, it rebounded over the next 24-48 hours to 1.64 mg/dL, requiring further administration of zoledronate 4 mg (Figure 1). Methylprednisolone 60 mg per day was subsequently instituted over the next 2 days with decrease in iCa level to 1.3-1.4 mg/dL (Figure 1). However, the patient continued to clinically deteriorate, despite iCa being maintained at 1.3-1.4 mg/dL (Figure 1) with development of multiorgan failure, and he expired shortly after.