Symmetrical bone scan in a patient with acute hypercalcemia

A previously healthy 49-year-old woman had symptoms of acute hypercalcemia that was not parathyroid-hormone mediated. Despite no clinical signs or symptoms of arthritis, a bone scan showed increased uptake in the juxtaarticular areas of the joints in the upper and lower extremities. The biopsy specimen of skeletal lesions noted on roentgenograms supported a diagnosis of multiple myeloma. Symmetrical lesions on bone scan in a patient with asymptomatic joints and acute hypercalcemia may be the first sign of an underlying hematologic malignant neoplasm.