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Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of non-Hodgkinlymphoma. It usually presents with nonspecific symptoms, such as fever, rather thanwith overt lymphadenopathy. Reports of hypercalcemia, as the initial presentation ofIVLBCL, are limited in the literature, despite it being a well-known complication of varioussolid cancers. We present a 68-year-old male with severe hypercalcemia andincreased levels of serum parathyroid hormone-related protein. He was diagnosedwith IVLBCL, involving the bone marrow and spleen, and was successfully treated withrituximab-containing chemotherapy. A few previous case reports have shown hypercalcemiain patients with IVLBCL. Much like our case, previous cases with hypercalcemiahad advanced diseases, including bone marrow invasion. Although it was anextremely rare manifestation of IVLBCL, we suggest that IVLBCL should be a part ofthe differential diagnosis in patients with unexplained hypercalcemia. Therefore, anactive work-up might be recommended, including positron emission tomography/computed tomography scan and bone marrow examination, which may be useful forearly diagnosis.

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