Abstract
Hypocalcemia is seldom encountered in patients with multiple myeloma. It is usually due to secondary causes. Most reported cause amongst this population is bisphosphonate therapy.
We report a case of a 65-year-old gentleman with a background of multiple myeloma presenting with worsening numbness and tingling in arms and legs. These symptoms eventually led to a fall.
Blood tests revealed severe hypocalcemia. He had never been on any bisphosphonates.
Despite repeated calcium replacement during admission, the severe hypocalcemia persisted, and his symptoms failed to resolve. His renal function, magnesium, albumin, creatine kinase and parathyroid hormone levels were within normal limits.
Further work up for hypocalcemia revealed marked hypovitaminosis D as the most probable cause. Following urgent Vitamin D replacement, the patient’s hypocalcemia resolved.
Severe resistant hypocalcemia in patients with multiple myeloma who are not or have never been on bisphosphonate therapy should raise the suspicion for other causes. Nutritional deficiencies like Vitamin D deficiency, once corrected, can lead to resolution of symptoms, preventing any future falls due to same reason, thereby reducing morbidity and mortality.