POSTOPERATIVE RECURRENCE TO THE PLEURA FROM ESOPHAGEAL CANCER WITH REMARKABLE HYPERCALCEMIA -A CASE REPORT-

A 56-year-old man who had been operated on for a cancer of the thoracic esophagus was admitted to the hospital with a suspicion of pleural recurrence on February 28, 1996. On March 14, dyspnea along with hallucination and disorientation appeared. Since severe impaired ventilation was noted, endotracheal intubation was emergently performed and the patient was entered the ICU. At that time, Ca level was 18.6mg/dl, showing significant hypercalcemia, and the white blood cell count increased to 18, 100/mm8. PTH-rP level in blood was as high as 260Pmol/ml. The elevated Ca level gradually decreased with a combinated use of elsitonine and bisphosphonate and his clinical condition became better, however, the Ca level converted to increase gradually since April 7, and appearance of arrhythmia and aggravation of ventilatory impairment were associated. On May 8, the patient died of abrupt cardiac arrest, when the white blood cell count was 21, 600/mm3 and Ca level was 14.8mg/dl. It is thought that hypercalcemia in this case might be caused by pleural recurrence of the esophageal cancer based on an increase in PTH-rP, and the cause of his death might be due to hypercalcemia crisis because the increase in Ca level was correlated with the clinical symptoms.