SUN-783 A Rare Case Of Severe Hypercalcemia Requiring Dialysis In A Patient With Adult T Cell Leukemia/lymphoma

Abstract Disclosure: A. Afzal: None. E. Haddad: None. P. Ucciferro: None. Introduction: Adult T cell leukemia is a malignancy of mature T lymphocytes caused by Human T cell Lymphotropic Virus. Most patients present with an elevated WBC count, enlarged lymph nodes, bone marrow involvement, organomegaly, skin lesions and hypercalcemia. The incidence of severe hypercalcemia is less than 1%, however the mortality of severe hypercalcemia associated with malignancy is as high as 50% within 30 days. Here we describe a case of severe hypercalcemia requiring dialysis in a patient with adult T cell leukemia / lymphoma. Case presentation: A 55-year-old male from Ghana with a past medical history of hypertension presented with 3 weeks of lethargy, loss of appetite, and a 20-pound weight loss. Lab workup was significant for a serum calcium of 20 mg/dl (8.7-10.2 mg/dl). PTH-Related peptide levels of 210 pg/ml (11-20 pg/ml). Computerized Tomography (CT) imaging revealed enlarged mediastinal, celiac, mesenteric, inguinal, and retroperitoneal lymph nodes. Excisional biopsy of the inguinal lymph node showed Adult T cell leukemia/lymphoma-HTLV-1 associated. He was started on continuous renal replacement therapy for hypercalcemic crisis. He also received 290 IU calcitonin twice daily for 4 doses, denosumab 120mg intravenously for one dose and 3 doses of methylprednisone 60 mg. Continuous bumetanide infusion was administered for calciuresis. Serum calcium improved to 10.8 mg/dl on day 4 of admission. The patient received 6 days of inpatient chemotherapy with EPOCH (Etoposide, vincristine, cyclophosphamide and Doxorubicin) and was eventually discharged home in a stable condition. Discussion: Current guidelines recommend treating severe hypercalcemia with intravenous hydration, calcitonin and bisphosphonate simultaneously. The benefits of hemodialysis for treating severe hypercalcemia are insufficiently acknowledged in the literature, though it can cause rapid reduction in serum calcium in patients with severe refractory hypercalcemia. Conclusion: Our case highlights the association of adult T cell leukemia with hypercalcemic crisis. It also draws attention to considering dialysis as an effective treatment modality in patients with hypercalcemic crisis who cannot be treated with conventional strategies due to cardiac and renal co-morbidities or have refractory hypercalcemia. Further studies are needed to establish the efficacy and utility of timely dialysis among patients with severe hypercalcemia. Presentation: Sunday, July 13, 2025