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Abstract: TH-PO853

Hypercalcemia of Humoral Malignancy After Kidney Transplant

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Tripuraneni, Srinath, University of Florida College of Medicine, Gainesville, Florida, United States
  • Belal, Amer Ashaab, University of Florida College of Medicine, Gainesville, Florida, United States
  • Mehta, Rohan V., University of Florida College of Medicine, Gainesville, Florida, United States
  • Santos, Alfonso, University of Florida College of Medicine, Gainesville, Florida, United States

Hypercalcemia of humoral malignancy (HHM) occurs due to a tumor-produced parathyroid hormone-related peptide (PTHrP) and is associated with increased morbidity and mortality. HHM typically presents with severe hypercalcemia (>13 mg/dl), decreased or normal parathyroid hormone (PTH), and elevated PTHrP with variable serum 25 hydroxy vitamin D levels. Although HHM has been associated with renal, bladder, breast, ovarian carcinomas and squamous cell carcinomas of the lung, head, and neck, it can very rarely can present with squamous cell carcinoma of the skin. We describe a case of HHM in a Kidney Transplant (KT) Recipient (KTR).

Case Description

A 41-year-old Black man with a history of KT in early 2019, ESRD from Hypertension and Dysplastic Kidneys with a baseline serum creatinine of 1.8-2.2 mg/dL was admitted for a groin mass. Relevant medical history included failed KT (2005), tertiary hyperparathyroidism s/p two lobe parathyroidectomy in 2018 (on sensipar), with baseline serum calcium 9.0-10.0mg/dL and baseline PTH of 200-400 pg/mL. The patient noted a perineal mass about two months prior to admission, that developed into a purulent and bleeding ulcer. Home medications included monthly Belatecept infusions, Mycophenolate 750 mg BID, and prednisone 5 mg daily. Laboratory data included serum creatinine 2.6 mg/dL, serum calcium 11 mg/dL, 25-OH vitamin D 18.71 ng/mL, and PTH of 133 pg/mL. Intravenous fluids were initiated, and a punch biopsy was performed by Dermatology. On post-admission day 7 with serum Calcium of 14.1 mg/dL, ionized calcium of 2.1 mmol/L, calcitonin was administered and sensipar was increased to 60 mg BID. Punch biopsy reported a well-differentiated squamous cell carcinoma, which was excised 10 days after admission. Serum Calcium dropped to 11.9 mg/dL, 4 days after surgery. PTHrP obtained before excision returned elevated at 60.2 pmol/L, while serum creatinine remained baseline. Serum Calcium had normalized to 9.2 mg/dL, about 4 weeks after surgery.


HHM has been associated with solid organ cancers but can occur with dermatologic malignancies. Clinicians should be aware of the possibility of HHM as a rare complication of squamous cell skin cancer. In patients with tertiary hyperparathyroidism, it can present with severe hypercalcemia, non-suppressed PTH, and an elevated PTHrP.