Background: Hypercalcemia can cause a multitude of nonspecific symptoms, although it can manifest as a life-threatening metabolic emergency. Several underlying causes should be considered in the emergency department (ED). Life-threatening hypercalcemia as the initial manifestation of primary plasma cell leukemia (pPCL) is quite unusual. Case presentation: We present a case of a 63-year-old man who presented to the emergency department with symptomatic hypercalcemia and acute renal failure that was linked to a diagnosis of pPCL. Despite adequate treatment, his course was associated with significant morbidity and was severe enough to threaten his life. Conclusion: Severe hypercalcemia with particular attention to the peripheral blood smear should alert physicians to this highly deadly entity.

Keywords: Primary plasma cell leukemia, hypercalcemia, peripheral blood smear, poor prognosis, emergency, case report.