A 70-year-old woman presented with back pain due to vertebral crush fractures and was found to have hypercalcaemia. Investigation revealed evidence of both primary hyperparathyroidism and Bence Jones myeloma and this was subsequently confirmed at necropsy. This is the first description of a case in which the simultaneous occurrence of both diseases was reliably established. The case illustrates the difficulty in identifying the cause of hypercalcaemia in some patients, and emphasises the need to consider the diagnosis of myeloma in all cases of hypercalcaemia.
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