case_images: PMC7102466_01
case_images: CT scan of the chest showing a 4.2 cm lobulated pleural-based mass in the right upper lobe with enlarged hilar lymph nodes suggestive of nodal metastasis.
case_images: CRIEM2020-4159526.001.jpg
case_images: PMC7102466_01_CRIEM2020-4159526.001.jpg
case_images: fig1
case_images: She was recently diagnosed with stage IV squamous cell cancer (SCC) of the lung (Figure 1).
case_images: Twelve-lead electrocardiogram (EKG) performed on admission with diffuse ST-segment elevations in leads V 3-6, II, III, and aVF. Vent rate 98 bpm, PR 146 ms, QRS 76 ms, QT 314 ms, and QTc 400 ms. Ca = 19.4 mg/dl and corrected Ca for albumin = 20.4 mg/dl.
case_images: CRIEM2020-4159526.002.jpg
case_images: PMC7102466_01_CRIEM2020-4159526.002.jpg
case_images: fig2
case_images: EKG revealed diffuse ST-segment elevation in leads V3-V6, I, II, III, and aVF (Figure 2).
case_images: Twelve-lead EKG performed 24 hours following admission showing less marked ST-segment elevation. Vent rate 98 bpm, PR interval 150 ms, QRS duration 76 ms, QT 328 ms, and QTc 418 ms. Ca = 14.2 mg/dl and corrected Ca for albumin = 15.4 mg/dl.
case_images: CRIEM2020-4159526.003.jpg
case_images: PMC7102466_01_CRIEM2020-4159526.003.jpg
case_images: fig3
case_images: By the following day, the corrected calcium level had decreased to 15.4 mg/dl, and a repeat EKG (Figure 3) showed partial resolution of the less ST-segment elevation.
case_images: Twelve-lead EKG performed 48 hours following admission showing resolution of ST-segment elevation. Vent rate 124 bpm, PR interval 152 ms, QRS duration 74 ms, QT 310 ms, and QTc 445 ms. Ca = 11.2 mg/dl and corrected Ca for albumin = 12.4 mg/dl.
case_images: CRIEM2020-4159526.004.jpg
case_images: PMC7102466_01_CRIEM2020-4159526.004.jpg
case_images: fig4
case_images: The EKG normalized by day 3 of treatment (Figure 4), while the calcium level reached its nadir at 11.2 mg/dL after a week of treatment.