Abstract

Background A 70-year-old man presented with a smooth lump on his buccal mucosa and right-sided cervical lymphadenopathy. Staging investigations revealed extensive sclerotic bone metastases and the patient subsequently underwent palliative radiotherapy to the right face and cervical region. Seven months later he presented with a 4-day history of fatigue, muscle cramps, ataxia, paraesthesia, and blurred vision. Investigations Physical examination, biopsy of abnormal buccal mucosa, routine biochemistry, electrocardiogram, bone scan, CT scans of the chest, abdomen and pelvis, and MRI of the brain. Diagnosis Undifferentiated carcinoma of the salivary gland with sclerotic bone metastases and hypocalcemia. Management Palliative radiotherapy to the right face and cervical region, infusions of calcium gluconate and calcium chloride, oral calcium carbonate, vitamin D and magnesium, palliative chemotherapy (carboplatin and 5-fluorouracil), and whole brain radiotherapy.