Background: Hypercalcemia can cause a multitude of nonspecific symptoms, although it can manifest as a life-threatening metabolic emergency. Several underlying causes should be considered in the emergency department (ED). Life-threatening hypercalcemia as the initial manifestation of primary plasma cell leukemia (pPCL) is quite unusual.
Case presentation: We present a case of a 63-year-old man who presented to the emergency department with symptomatic hypercalcemia and acute renal failure that was linked to a diagnosis of pPCL. Despite adequate treatment, his course was associated with significant morbidity and was severe enough to threaten his life.
Conclusion: Severe hypercalcemia with particular attention to the peripheral blood smear should alert physicians to this highly deadly entity.
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