Singh Balraj, Gogia Pooja, Kaur Parminder, Guragai Nirmal, Maroules Michael
Hematology & Oncology Department, Saint Joseph's University Medical Center, Paterson, NJ, USA.
Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, NJ, USA.
Eur J Case Rep Intern Med. 2020 Dec 21;7(12):002140. doi: 10.12890/2020_002140. eCollection 2020.
Calcium elevation, Renal dysfunction, Anaemia and Bone disease (CRAB criteria) are usually seen in multiple myeloma (MM). We report a unique case of lymphoma with all the features of CRAB criteria. We describe a 59-year-old patient who presented with confusion, severe back pain, fatigue and constipation and was found to have hypercalcaemia, kidney dysfunction, anaemia and multiple osteolytic lesions. Physical examination and imaging did not reveal any enlarged lymph nodes. Work-up for MM (serum protein electrophoresis, serum immunofixation, bone marrow biopsy) was negative. The patient was diagnosed with diffuse large B-cell lymphoma based on a pelvic mass biopsy. Hence, our case report suggests that CRAB criteria are not pathognomonic of MM and that in the appropriate clinical scenario, lymphoma is a possible diagnosis.
The CRAB criteria consist of end-organ damage with hypercalcaemia, renal dysfunction, anaemia and bone involvement.The CRAB criteria are not pathognomonic of multiple myeloma, and in the appropriate clinical scenario, lymphoma is a possible diagnosis.Major mechanisms by which hypercalcaemia of malignancy can occur are tumour secretion of parathyroid hormone-related protein (PTHrP), osteolytic metastases with local release of cytokines, or tumour production of 1,25-dihydroxyvitamin D (calcitriol).
高钙血症、肾功能不全、贫血和骨病（CRAB标准）通常见于多发性骨髓瘤（MM）。我们报告了一例具有CRAB标准所有特征的淋巴瘤罕见病例。我们描述了一名59岁的患者，其表现为意识模糊、严重背痛、疲劳和便秘，被发现患有高钙血症、肾功能不全、贫血和多处溶骨性病变。体格检查和影像学检查未发现任何肿大的淋巴结。MM相关检查（血清蛋白电泳、血清免疫固定电泳、骨髓活检）结果均为阴性。根据盆腔肿块活检，该患者被诊断为弥漫性大B细胞淋巴瘤。因此，我们的病例报告表明，CRAB标准并非MM所特有，在适当的临床情况下，淋巴瘤也是一种可能的诊断。
CRAB标准包括高钙血症、肾功能不全、贫血和骨受累导致的终末器官损害。CRAB标准并非多发性骨髓瘤所特有，在适当的临床情况下，淋巴瘤也是一种可能的诊断。恶性肿瘤导致高钙血症的主要机制包括肿瘤分泌甲状旁腺激素相关蛋白（PTHrP）、溶骨性转移伴细胞因子局部释放或肿瘤产生1,25 - 二羟维生素D（骨化三醇）。
