Abstract: SA-PO0544
Posterior Reversible Encephalopathy Syndrome Triggered by Hypercalcemia: An Atypical Debut of Multiple Myeloma
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 3
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Maldonado-Ruiz, David Antonio, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Aranda, Andres, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Ruiz Fabian, Linda Giovanna, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Enriquez Barajas, Christian Michel, Universidad de Guadalajara Centro Universitario de Ciencias de la Salud, Guadalajara, Jal., Mexico
- Bermudez Ferro, Karla Eugenia, Hospital Angeles del Carmen, Guadalajara, Jal., Mexico
- Leon-Velasco, Fausto Raymond, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Diaz Adames, Dharaliz, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Antompietri Lugo, Adolfo Alejandro, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Rivera Maldonado, Naara Ivana, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Paez Morales, Emily, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Rodriguez, Guadalupe, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Marrero Santiago, Erick Ivan, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Flores Arevalo, Fatima Del Rocio, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Ahmad, Kashif A, Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
Group or Team Name
- Nephrology Interest Group School of Medicine UAG.
Introduction
Posterior reversible encephalopathy syndrome (PRES) is a neurological condition with symptoms ranging from altered mental status and seizures to coma. Although most commonly linked to hypertension, other causes have been described. In multiple myeloma, PRES has been associated with treatment. Hypercalcemia is a potential precipitating factor, though its prevalence as an initial manifestation remains unclear.
Case Description
A 70 yo man with HBP and dyslipidemia presented with back pain after a fall. Initially hospitalized for a suspected vertebral fracture but discharged after developing hyperactive delirium. Two days later, he was readmitted with reduced consciousness, apnea, and severe hypercalcemia >1.60 mmol/L. Labs also showed elevated creatinine (2.08 mg/dL) and BUN >110 mg/dL.
Despite IV fluids and diuretics, hypercalcemia persisted. Following sedation withdrawal, he had a generalized seizure. MRI revealed subcortical and cerebellar changes consistent with PRES. EEG showed right-sided epileptiform activity. Bone marrow biopsy confirmed >10% plasma cells, and immunofixation revealed an IgA lambda protein.
He was treated with denosumab, which normalized calcium levels but led to hypocalcemia requiring oral supplementation. With full clinical and neurological improvement after CyBorD treatment.
Discussion
This case underscores the need for rapid, thorough evaluation of hypercalcemia, especially in atypical presentations without anemia or lytic bone lesions, as early treatment improves neurological recovery.