Hypercalcaemia as an immune-related adverse event secondary to ipilimumab and nivolumab therapy in a patient with metastatic renal cell carcinoma
Department
Internal Medicine
Additional Department
Nephrology
Document Type
Article
Publication Title
BMJ Case Reports
Abstract
We report a case of severe hypercalcaemia after a single cycle of a combination therapy of ipilimumab and nivolumab. Initial evaluation ruled out common causes, including bone metastases, parathyroid hormone/parathyroid hormone-related protein elevation and paraproteinaemia. Her serum 1,25-dihydroxyvitamin D (calcitriol) levels were significantly elevated following the first immunotherapy cycle. Hypercalcaemia responded only to glucocorticoid therapy, with normalisation of serum calcium and calcitriol levels. Recurrence of hypercalcaemia after glucocorticoid discontinuation and subsequent resolution with glucocorticoid re-initiation strongly supported a calcitriol-mediated mechanism, most likely as an immune-related effect of ipilimumab and nivolumab.
First Page
e266771
DOI
10.1136/bcr-2025-266771
Volume
19
Issue
2
Publication Date
2-10-2026
Medical Subject Headings
Humans; Hypercalcemia; Nivolumab; Ipilimumab; Carcinoma, Renal Cell; Female; Kidney Neoplasms; Antineoplastic Agents, Immunological; Glucocorticoids; Calcitriol; Middle Aged
PubMed ID
41667199
Recommended Citation
Osman, H., Sanjeevi, A., & Hsu, C. (2026). Hypercalcaemia as an immune-related adverse event secondary to ipilimumab and nivolumab therapy in a patient with metastatic renal cell carcinoma. BMJ Case Reports, 19 (2), e266771. https://doi.org/10.1136/bcr-2025-266771