Purpose: The purpose of this report is to increase awareness into various forms of tumor lysis syndrome (TLS) in patients with multiple myeloma, prompting recognition and management.

Case Presentation: We herein describe a patient with multiple myeloma who developed hypercalcemia in the setting of tumor lysis syndrome while receiving therapy. On the eighth day after treatment with Bortezomib and dexamethasone, our patient developed abdominal pain and obstipation. Examination revealed borderline vital signs along with signs of peritonitis. Biochemical profile revealed evidence of hypercalcemia in context of TLS and an acute kidney injury. Imaging showed signs of small bowel obstruction. The patient improved with aggressive hydration, anti-hyperkalemic measures, Rasburicase and Dexamethasone, after which she underwent urgent exploratory laparotomy with resection and anastomosis for impeding perforation. Although our patient had some reported risk factors for developing TLS, the case was atypical in terms of delayed presentation as well as an uncharacteristic presentation and biochemical findings in relation to TLS.

Conclusion: As TLS is a condition associated with high morbidity and mortality, the presence of hypercalcemia in context of an appropriate clinical setting should not delay or derail recognition and management of TLS.