Hypocalcemia associated with bone metastases in a patient with salivary-gland carcinoma.

BACKGROUND: A 70-year-old man presented with a smooth lump on his buccal mucosa and right-sided cervical lymphadenopathy. Staging investigations revealed extensive sclerotic bone metastases and the patient subsequently underwent palliative radiotherapy to the right face and cervical region. Seven months later he presented with a 4-day history of fatigue, muscle cramps, ataxia, paraesthesia, and blurred vision. INVESTIGATIONS: Physical examination, biopsy of abnormal buccal mucosa, routine biochemistry, electrocardiogram, bone scan, CT scans of the chest, abdomen and pelvis, and MRI of the brain. DIAGNOSIS: Undifferentiated carcinoma of the salivary gland with sclerotic bone metastases and hypocalcemia. MANAGEMENT: Palliative radiotherapy to the right face and cervical region, infusions of calcium gluconate and calcium chloride, oral calcium carbonate, vitamin D and magnesium, palliative chemotherapy (carboplatin and 5-fluorouracil), and whole brain radiotherapy.