A 72-Year-Old Woman With Back Pain and Hypercalcemia

Tarah Ballinger, MD; Kathy D. Miller, MD

Disclosures

July 27, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 72-year-old woman presents to her primary care physician because of worsening lower back pain. She has a known history of osteoarthritis and chronic back pain, which is usually helped with steroid injections and over-the-counter nonsteroidal anti-inflammatory medications. However, she had injections the week before her presentation and is taking multiple doses of naproxen each day without the usual relief. She denies any weakness or numbness of the lower extremities. She is otherwise feeling well and is a very active woman who regularly exercises.

The patient's medical history is significant for right knee, right hand, and left shoulder surgeries owing to osteoarthritis. Ten years ago, she was diagnosed with stage I estrogen receptor (ER)-positive, human epidermal growth factor receptor (HER2)-negative invasive ductal carcinoma of the breast. Her breast cancer was treated with lumpectomy and axillary lymph node dissection. She had an intermediate risk score for recurrence and proceeded with adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) and radiation therapy. She completed 5 years of adjuvant antiestrogen therapy with the aromatase inhibitor anastrozole. She has been compliant in her follow-up, with normal mammogram findings approximately 6 months ago.

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