When the patient’s autoimmune disorder did not respond to treatment, an additional workup uncovered a malignancy—one with an undefined connection. A 73-year-old woman presented with fatigue, left upper quadrant pain, headache, nausea, and cognitive dysfunction. An initial workup revealed hypercalcemia, a low level of parathyroid hormone, elevated levels of angiotensin-converting enzyme and alkaline phosphatase, pancytopenia, and mediastinal lymphadenopathy (Table). While magnetic resonance imaging of her brain produced unremarkable results, abdominal imaging showed trace ascites, mild splenomegaly with calcified granulomas, and borderline hepatomegaly.