Diffuse Large B-Cell Lymphoma Causing Melena, Gastric Ulcer, Liver Mass, and Hypercalcemia

This is a case of a woman in her 70s who demonstrated an uncommon presentation and consequence of diffuse large B-cell lymphoma (DLBCL). She presented with a month of generalized weakness and 1-2 weeks of melena. She was found to be anemic and had 1,25-dihydroxyvitamin D (calcitriol)-mediated hypercalcemia. Computed tomography (CT) of the abdomen and pelvis revealed a liver mass. Esophagogastroduodenoscopy (EGD) showed a gastric ulcer, biopsied without evidence of active bleeding. Liver mass was biopsied. Positron emission tomography scan demonstrated an F-18 fluorodeoxyglucose (FDG)-avid hepatic mass with an FDG-avid lymphadenopathy above and below the diaphragm. Gastric biopsy was consistent with a lymphoma, and liver biopsy returned positive for DLBCL. She received two units of packed red blood cells. With comorbidities of heart failure and chronic kidney disease, she was judiciously given isotonic saline, calcitonin, prednisone, and denosumab for hypercalcemia.