A Rare Case of Hypercalcemic Crisis Secondary to a Squamous Cell Carcinoma Arising from a Nonhealing Ulcer

ABSTRACT Objective: To report a case of hypercalcemic crisis in an African American male who presented with a nonhealing ulcer which was later found to be squamous cell carcinoma. Methods: All relevant data, radiologic imaging, and pathology reports were reviewed in detail. An in-depth literature review for humoral hypercalcemia of malignancy and cutaneous squamous cell carcinoma was performed using MEDLINE. Results: A 58-year-old man with a history of chronic lymphedema presented with fever and a nonhealing left foot ulcer. Initial studies revealed acute kidney injury, anemia, and non–parathyroid hormone (PTH)-mediated hypercalcemic crisis (calcium, 17.7 mg/dL). A thorough work-up ruled out bone metastasis and confirmed increased PTH-related peptide, which is the hallmark of humoral hypercalcemia of malignancy (HHM). Hypercalcemia was initially managed with intravenous fluid hydration, bisphosphonates, and calcitonin. The patient had surgical resection of the left leg, and pathology revealed cutaneous squamous cell carcinoma. Hypercalcemia resolved completely after surgical resection of the tumor. Conclusion: Clinicians should be aware of the possibility of HHM as a rare complication associated with squamous cell carcinoma arising from nonhealing ulcers. Abbreviations: HHM humeral hypercalcemia of malignancy; PTH parathyroid hormone; PTHrP parathyroid hormone–related peptide; SCC squamous cell carcinoma