Pancytopenia and Hypocalcemia: An Unexpected Cause

Pancytopenia refers to the simultaneous reduction of all peripheral blood cell lines and is a hematologic finding often indicative of severe and potentially life-threatening disease. Although usually not associated, hypocalcemia and pancytopenia may co-occur, suggesting a common etiology. We report a case of a caucasian woman in her late 50s with asthenia, paraesthesia and nausea. Laboratory results showed severe hypocalcemia, anemia, elevated alkaline phosphatase and lactate dehydrogenase. A computed tomography scan revealed extensive osteosclerosis, suggesting osteoblastic metastasis. Progression to pancytopenia prompted bone marrow evaluation, ultimately leading to the diagnosis of signet-ring cell gastric adenocarcinoma. Unfortunately, the patient died shortly after diagnosis. This case illustrates a rare presentation of gastric adenocarcinoma, featuring hypocalcemia due to osteoblastic metastases and pancytopenia from bone marrow infiltration - an association infrequently reported in the literature - and emphasizes that this unusual constellation of findings may be the first clue to an otherwise unsuspected solid malignancy.