{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:13:51Z","timestamp":1790241231780,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T00:00:00Z","timestamp":1760227200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hypercalcemia is a common, serious complication in patients with malignancy and is associated with significant morbidity. Compared to patients with solid tumor malignancies, the reported incidence of hypercalcemia in patients with indolent lymphoid malignancies is lower and rare in those with chronic lymphocytic leukemia\/small lymphocytic lymphoma (CLL\/SLL). In this report, we describe the case of a patient with a history of CLL\/SLL previously treated with multiple lines of therapy and thought to be in remission who presented with symptomatic, severe hypercalcemia. Her calcium initially improved; however, it increased after discontinuation of steroids despite aggressive fluid resuscitation, calcitonin, and bisphosphonate therapy. Following an extensive laboratory and radiographic evaluation, her hypercalcemia was concluded to be secondary to elevation in serum parathyroid hormone\u2010related peptide in the setting of recurrent CLL\/SLL. Notably, the patient had no evidence of Richter transformation and initially responded well to steroids, denosumab, and CLL\u2010directed therapy; however, she later had refractory CLL\/SLL and hypercalcemia. Hematologic malignancy, including CLL\/SLL, could be considered in the differential diagnosis of hypercalcemia and can be present either at the time of initial diagnosis or signal disease relapse in the appropriate context.<\/jats:p>","DOI":"10.1002\/ccr3.71181","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T03:53:56Z","timestamp":1760327636000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relapsed Chronic Lymphocytic Leukemia Heralded by Parathyroid Hormone Related Peptide\u2010Mediated Hypercalcemia"],"prefix":"10.1002","volume":"13","author":[{"given":"Srikar","family":"Tallavajhala","sequence":"first","affiliation":[{"name":"Department of Medicine University of Virginia Health System  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Virginia Health System  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6076-7084","authenticated-orcid":false,"given":"Sean C.","family":"Dougherty","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Medicine University of Virginia Health System  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett R.","family":"Kurpiel","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Virginia Health System  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig A.","family":"Portell","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Medicine University of Virginia Health System  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,12]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp042806"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.med.45.1.189"},{"issue":"6","key":"e_1_2_13_4_1","first-page":"635","article-title":"Hypercalcemia in Malignancy","volume":"153","author":"Strewler G. J.","year":"1990","journal-title":"Western Journal of Medicine"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/1947\u20102714.170600"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnab005"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097\u20100142(19811001)48:7<1643::aid\u2010cncr2820480728>3.0.co;2\u20109"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem\u201068\u20105\u2010976"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/bcr3129"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002\u20109343(97)89515\u20100"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2019.1672055"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2017.12.006"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010121\u20109\u2010199411010\u201000001"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/5525721"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000314646"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2015.06.007"},{"issue":"12","key":"e_1_2_13_17_1","article-title":"Parathyroid\u2010Hormone\u2010Related\u2010Protein\u2010Associated Hypercalcemia in a Patient With CLL\u2010Type Low\u2010Grade Leukemic B\u2010Cell Lymphoma","volume":"91","author":"Schottker B.","year":"2006","journal-title":"Haematologica"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1159\/000455913"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096\u20108652(199612)53:4<245::AID\u2010AJH7>3.0.CO;2\u2010Y"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102141.1994.tb06752.x"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1979.03630480079024"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.18331"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199011083231907"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.83.8.5025"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.1946"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1908213"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp2113128"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014\u20101001"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgac621"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014\u20104250"},{"issue":"20","key":"e_1_2_13_31_1","first-page":"4517","article-title":"Induction of Parathyroid Hormone\u2010Related Peptide by the Ras Oncogene: Role of Ras Farnesylation Inhibitors as Potential Therapeutic Agents for Hypercalcemia of Malignancy","volume":"57","author":"Aklilu F.","year":"1997","journal-title":"Cancer Research"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.644303"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1615\/critreveukaryotgeneexpr.v15.i2.30"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/bs.vh.2022.03.002"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71181","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.71181","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71181","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:52:21Z","timestamp":1790239941000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.71181"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":33,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/ccr3.71181"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.71181","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2024-11-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71181"}}