Abstract
INTRODUCTION: Hypercalcemia is a common paraneoplastic syndrome rarely seen in chronic lymphocytic leukemia (CLL). When it occurs, it often signals disease progression or Richter transformation. Disruption of cancer care in conflict zones may contribute to worsening clinical outcomes. CASE PRESENTATION: We report a 63-year-old Arab female with a 3-year history of CLL, previously treated with chlorambucil and rituximab, who developed severe hypercalcemia (total calcium 19.9 mg/dL) after an 8-month interruption of chemotherapy due to transportation barriers amid regional conflict. She presented with confusion, weakness, polyuria, and polydipsia. Laboratory evaluation showed suppressed parathyroid hormone, normal vitamin D, renal impairment, and no evidence of lytic bone lesions. Treatment with intravenous fluids, calcitonin, and zoledronic acid effectively lowered calcium levels. Despite reinitiation of chemotherapy, she later developed fatal febrile neutropenia and septic shock. CONCLUSION: This case highlights a rare but serious complication of CLL and underscores the detrimental impact of healthcare disruption on disease progression and outcomes. Clinicians should maintain vigilance for hypercalcemia in hematologic malignancies, even during remission, and prioritize continuity of care in vulnerable populations.