Hypercalcemic Encephalopathy as an Initial Presentation of Multiple Myeloma.

Area of Science:

• Neurology
• Oncology
• Internal Medicine

Background:

• Multiple myeloma is a hematologic malignancy characterized by uncontrolled proliferation of plasma cells.
• Encephalopathy, a general term for brain dysfunction, can arise from various metabolic disturbances.
• Hypercalcemia, or elevated serum calcium, is a known complication of multiple myeloma.

Observation:

• An 84-year-old female presented with acute altered sensorium, with neurological and infectious causes excluded.
• Investigations revealed significantly elevated serum calcium (15.07 gm/dl).
• High total protein and globulin levels suggested a potential underlying malignancy.

Findings:

• The patient was diagnosed with hypercalcemic encephalopathy and multiple myeloma.
• Confirmation was achieved through serum protein electrophoresis, immunofixation, and bone marrow examination.
• Treatment with bortezomib, dexamethasone, and lenalidomide led to clinical improvement and normalization of serum calcium within one week.

Implications:

• Hypercalcemia should be considered in the differential diagnosis of encephalopathy, especially in elderly patients.
• Metabolic encephalopathy can be the initial presenting symptom of multiple myeloma.
• Prompt diagnosis and management of hypercalcemia in multiple myeloma patients are crucial for neurological recovery.