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Yu T, Bruce S, Nguyen D, Patel A, MacElwee M. The Use of Steroids to Treat Hypercalcemia Due to Granulomatous Disease From Disseminated Coccidioidomycosis. Cureus 2024; 16:e63977. [PMID: 39104975 PMCID: PMC11299706 DOI: 10.7759/cureus.63977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2024] [Indexed: 08/07/2024] Open
Abstract
The clinical course and treatment of hypercalcemia from a granulomatous disease in the setting of an infectious etiology, namely disseminated coccidioidomycosis, remains incompletely understood. The mechanism and treatment of hypercalcemia have been documented in most granulomatous disorders, with sarcoidosis being the most well-understood so far. We discuss a case of a patient with a recent diagnosis of disseminated coccidioidomycosis who presented with hypercalcemia despite adequate infection control. The treatment course involved combinatorial-calcitonin, low-dose bisphosphonates, and corticosteroids, which led to a favorable outcome.
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Affiliation(s)
- Tim Yu
- Department of Internal Medicine, Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, USA
| | - Stephen Bruce
- Department of Internal Medicine, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Diep Nguyen
- Department of Radiology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Anika Patel
- Department of Internal Medicine, Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, USA
| | - Mark MacElwee
- Department of Internal Medicine, Valleywise Health Medical Center, Phoenix, USA
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Abstract
Sarcoidosis is a systemic inflammatory disease of unknown etiology. The pathogenesis rests on an aberrant T cell response to unidentified antigens in individuals predisposed by genetic and environmental factors. Increased expression of polarized macrophages and disequilibrium between effector and regulator T cells contribute to the formation of noncaseating granulomas, that are frequently found in affected organs. The main kidney abnormalities in sarcoidosis are granulomatous interstitial nephritis (GIN) and hypercalcemia-related disorders. The clinical diagnosis is difficult. The outcome is variable, ranging from spontaneous remission to end-stage kidney disease (ESKD). Early diagnosis and prompt treatment with corticosteroids can improve the prognosis. Hypercalcemia may be responsible for acute kidney injury (AKI) caused by vasoconstriction of afferent arterioles. Complications of persistent hypercalcemia include nephrocalcinosis and renal stones. In patients with ESKD, dialysis and transplantation can offer results comparable to those observed in patients with other causes of kidney failure. Based on a review of the literature, we present an overview of the etiopathogenesis, the renal manifestations of sarcoidosis and their complications, management and prognosis.
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Haykal T, Sundus S, Bachuwa G, Danish R. Primary isolated hepatosplenic sarcoidosis mimicking malignancy and causing symptomatic hypercalcaemia. BMJ Case Rep 2019; 12:12/1/e227703. [PMID: 30674496 DOI: 10.1136/bcr-2018-227703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This is a case of a 67-year-old woman, known to have multiple medical problems, mainly papillary thyroid cancer status post-total thyroidectomy and cervical neck dissection in addition to radioactive iodine currently in remission for 1 year, who presented to the hospital with severe weakness and fatigue. The initial workup showed significant hypercalcaemia and suppressed Parathyroid hormone (PTH). The patient was treated with hydration and pamidronate and her hypercalcaemia and symptoms improved. The differential was wide, however, a CT scan of the chest, abdomen and pelvis did show multiple liver and splenic nodular lesions; therefore, malignancy was the highest possible diagnosis. Biopsy of the splenic lesion confirmed the diagnosis of sarcoidosis. Therefore, the patient was diagnosed with primary isolated nodular hepatosplenic sarcoidosis mimicking malignancy and causing significant symptomatic hypercalcaemia.
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Papaioannou O, Karampitsakos T, Barbayianni I, Chrysikos S, Xylourgidis N, Tzilas V, Bouros D, Aidinis V, Tzouvelekis A. Metabolic Disorders in Chronic Lung Diseases. Front Med (Lausanne) 2018; 4:246. [PMID: 29404325 PMCID: PMC5778140 DOI: 10.3389/fmed.2017.00246] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/18/2017] [Indexed: 12/16/2022] Open
Abstract
Chronic lung diseases represent complex diseases with gradually increasing incidence, characterized by significant medical and financial burden for both patients and relatives. Their increasing incidence and complexity render a comprehensive, multidisciplinary, and personalized approach critically important. This approach includes the assessment of comorbid conditions including metabolic dysfunctions. Several lines of evidence show that metabolic comorbidities, including diabetes mellitus, dyslipidemia, osteoporosis, vitamin D deficiency, and thyroid dysfunction have a significant impact on symptoms, quality of life, management, economic burden, and disease mortality. Most recently, novel pathogenetic pathways and potential therapeutic targets have been identified through large-scale studies of metabolites, called metabolomics. This review article aims to summarize the current state of knowledge on the prevalence of metabolic comorbidities in chronic lung diseases, highlight their impact on disease clinical course, delineate mechanistic links, and report future perspectives on the role of metabolites as disease modifiers and therapeutic targets.
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Affiliation(s)
- Ourania Papaioannou
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Karampitsakos
- 5th Department of Respiratory Medicine, Hospital for Diseases of the Chest "Sotiria", Athens, Greece
| | - Ilianna Barbayianni
- Department of Internal Medicine, Section of Pulmonary Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Serafeim Chrysikos
- 5th Department of Respiratory Medicine, Hospital for Diseases of the Chest "Sotiria", Athens, Greece
| | - Nikos Xylourgidis
- Department of Internal Medicine, Section of Pulmonary Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Vasilis Tzilas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilis Aidinis
- Division of Immunology, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Argyrios Tzouvelekis
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Division of Immunology, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
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