Hypercalcaemia, Renal Dysfunction, Anaemia, Bone Disease (CRAB Criteria): A Case of Lymphoma

  • Balraj Singh Hematology & Oncology Department, Saint Joseph's University Medical Center, Paterson, NJ, USA https://orcid.org/0000-0001-7986-6031
  • Pooja Gogia Internal Medicine Department, Saint Peter’s University Hospital, New Brunswick, NJ, USA
  • Parminder Kaur Cardiology Department, Saint Joseph’s University Medical Center, Paterson, NJ, USA https://orcid.org/0000-0002-7015-3489
  • Nirmal Guragai Cardiology Department, Saint Joseph’s University Medical Center, Paterson, NJ, USA
  • Michael Maroules Hematology & Oncology Department, Saint Joseph's University Medical Center, Paterson, NJ, USA

Keywords

Hypercalcemia, anemia, osteolytic lesions, lymphoma, multiple myeloma

Abstract

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.

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References

  • Li S, Young KH, Medeiros LJ. Diffuse large B-cell lymphoma. Pathology 2018;50(1):74–87.
  • Rajkumar SV. Multiple myeloma: every year a new standard? Hematol Oncol 2019;37(Suppl 1):62–65.
  • Abdullah HMA, Ellithi M, Waqas Q, Cunningham A, Oliver T. Hypercalcaemia, renal dysfunction, anaemia and bone lesions (CRAB) do not always represent multiple myeloma: diffuse large B cell lymphoma presenting with CRAB symptoms in a 69-year-old man. BMJ Case Rep 2019;12(8):e229070.
  • Greenberg AJ, Rajkumar SV, Therneau TM, Singh PP, Dispenzieri A, Kumar SK. Relationship between initial clinical presentation and the molecular cytogenetic classification of myeloma. Leukemia 2014;28(2):398–403.
  • Dang M, Gajendra S, Goel S, Jha B, Sahni T, Sachdev R. Diffuse large B cell lymphoma with high M protein: an unusual finding. Blood Res 2015;50(1):61–62.
  • Cook L, Macdonald DHC. Management of paraproteinaemia. Postgrad Med J 2007;83(978):217–223.
  • Mirrakhimov AE. Hypercalcemia of malignancy: an update on pathogenesis and management. N Am J Med Sci 2015;7(11):483–493.
  • Conte GA, Harmon JS, Le ML, Sun X, Schuler JW, Levitt MJ, et al. Hypercalcemia in T-cell/histiocyte-rich large B-cell lymphoma: an unusual presentation of a rare disease and literature review. World J Oncol 2019;10(6):231–236.
  • Goldner W. Cancer-related hypercalcemia. J Oncol Pract 2016;12(5):426–432.
  • Rosner MH, Perazella MA. Acute kidney injury in the patient with cancer. Kidney Res Clin Pract 2019;38(3):295–308.
  • Ghosh J, Singh RK, Saxena R, Gupta R, Vivekanandan S, Sreenivas V, et al. Prevalence and aetiology of anaemia in lymphoid malignancies. Natl Med J India 2013;26(2):79–81.
  • Dicato M, Plawny L, Diederich M. Anemia in cancer. Ann Oncol 2010;21 Suppl 7:vii167–72.
  • Tsuzuki S, Park SH, Eber MR, Peters CM, Shiozawa Y. Skeletal complications in cancer patients with bone metastases. Int J Urol 2016;23(10):825–832.
  • Published: 2020-12-21

    Issue: Vol 7 No 12 (view)

    Section: Articles

    How to cite:
    1.
    Singh B, Gogia P, Kaur P, Guragai N, Maroules M. Hypercalcaemia, Renal Dysfunction, Anaemia, Bone Disease (CRAB Criteria): A Case of Lymphoma. EJCRIM 2020;7 doi:10.12890/2020_002140.