case_images: PMC9839403_01
case_images: This graph shows the trend in the levels of calcium and creatinine throughout the patient's hospitalization as various treatments were provided as labeled above. "Day 0" is one day prior to pembrolizumab administration. "Day 94" represents post hospitalization recheck of laboratory studies. The X axis represents time measured in days. The left Y axis illustrates creatinine levels in mg/dL. The right Y axis demonstrates the calcium levels in mg/dL. The green dashed lines indicate the start dates for denosumab and the blue dash vertical dash lines indicate the start dates for methylprednisolone.
case_images: CRIN2023-9160326.001.jpg
case_images: PMC9839403_01_CRIN2023-9160326.001.jpg
case_images: fig1
case_images: While admitted routine laboratory studies were significant for concurrent rising serum calcium to 13.1 mg/dl and serum creatinine of 2.80 mg/dL which peaked at 4.06 mg/dL (known baseline of 1.3-1.4 mg/dL), which is summarized in Figure 1. D level, elevated 1,25 dihydroxy vitamin D (calcitriol) of 143 pg/mL, and normal ACE. Despite 72 hours of aggressive treatment, his hypercalcemia was minimally responsive, as shown in Figure 1.