title: An interesting case of systemic lupus erythematosus presenting with hypercalcemia: A diagnostic dilemma.
abstract: BACKGROUND
  Hypercalcemia is common in primary hyperparathyroidism malignancies and even in tuberculosis. Interestingly, systemic lupus erythematosus (SLE) rarely presents with hypercalcemia.
  
  
  METHODS
  We describe an interesting case of SLE in a patient who was otherwise thought to have either tuberculosis or a malignancy. The patient initially presented with feeling unwell, with generalized lymphadenopathy, bilateral pleural effusion, and bilateral corneal calcium deposits secondary to severe hypercalcemia. The diagnosis of SLE was made based on positivity of antinuclear antibodies (ANA) and anti-dsDNA, the presence of serositis, lymphadenopathy, autoimmune hemolytic anemia, and constitutional symptoms. She was treated with steroids, with tremendous improvement in her general well-being, resolution of lymphadenopathy and pleural effusion, and normalization of her hemoglobin and serum calcium. The atypical presentation of SLE with hypercalcemia with pleural effusion is discussed.
  
  
  CONCLUSIONS
  SLE should be one of the differential diagnoses in patients presenting with severe hypercalcemia.
authors.affiliation: Faculty of Medicine, Universiti Kebangsaan,Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Abdul Halim
authors.initials: AH
authors.lastname: Abdul Gafor
authors.forename: Rizna Abdul
authors.initials: RA
authors.lastname: Cader
authors.forename: Srijit
authors.initials: S
authors.lastname: Das
authors.forename: Noraidah
authors.initials: N
authors.lastname: Masir
authors.forename: Fadilah Abdul
authors.initials: FA
authors.lastname: Wahid
keywords: atypical presentation; hypercalcemia; systemic lupus erythematosus