Introduction In young adults with severe hypercalcemia, both classically associated adult and pediatric causes must be considered. Here, we detail the report of a 21‐year‐old male whose case highlights an atypical presentation of severe hypercalcemia with predominant neuropsychiatric symptoms due to classical Hodgkin’s lymphoma. Case Description This is a 21‐year‐old male without any past medical history who initially presented to urgent care to seek medical attention for shortness of breath, nausea, vomiting, fatigue, and dyspnea on exertion, at which time he was diagnosed with anxiety without a full medical evaluation. Due to persistent symptoms, he presented to primary care 1 month later and was found to have severe hypercalcemia and acute kidney injury. A large pleural effusion and mediastinal mass were found, and biopsy revealed classical Hodgkin’s lymphoma, nodular sclerosing subtype. His symptoms abated with initiation of chemotherapy. Discussion In young adults with severe hypercalcemia, both adult and pediatric malignancies should be considered as an etiology. Hypercalcemia of malignancy occurs less frequently in pediatric and young adult patients, and while Hodgkin’s lymphoma is one of the most common malignancies in young adults, the nodular sclerosing subtype is a rare cause of severe hypercalcemia, with few cases reported. Neuropsychiatric symptoms in particular are a common comorbid symptom in hypercalcemia and range from anxiety, depression, confusion, and cognitive dysfunction with memory loss to hypotonia, seizures, and coma. The prevalence of anxiety disorders has been rising in the last decade, particularly after the COVID‐19 pandemic; however, for patients with symptoms suggestive of an underlying medical etiology, additional workup is necessary. Conclusion Hypercalcemia can cause a wide spectrum of clinical manifestations and must be considered in the differential diagnosis of neuropsychiatric complaints even for presumably healthy young adults. Our patient’s age and underlying diagnosis of the nodular sclerosing subtype of Hodgkin lymphoma make his presentation due primarily to neuropsychiatric symptoms of malignant hypercalcemia all the more rare.
Kagalwalla et al. (Thu,) studied this question.