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Flowers RC, Ocampo J, Krautbauer J, Kupin WL. Hypercalcaemia in Mycobacterium kansasii pulmonary infection. BMJ Case Rep 2021; 14:e245800. [PMID: 34848413 PMCID: PMC8634358 DOI: 10.1136/bcr-2021-245800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 12/25/2022] Open
Abstract
A gentleman in his 60s with end-stage kidney disease status post kidney transplantation on prednisone and tacrolimus presented with generalised weakness for 7 days, associated with altered mental status. Investigations revealed pancytopenia, acute kidney injury, hypercalcaemia, decreased parathyroid hormone (PTH) and normal calcitriol levels. CT of the chest showed multifocal lung opacities suspicious for malignancy. Bronchoscopy with biopsy yielded no malignant cells, and bronchoalveolar lavage specimens grew Mycobacterium kansasii The patient was treated with bisphosphonates, calcitonin and antibiotics for non-tuberculous mycobacteria pulmonary infection, with improvement in serum calcium levels, and was discharged after 5 weeks of hospitalisation.The work-up for hypercalcaemia begins with PTH measurement, and low PTH levels are consistent with malignancy, immobilisation and granulomatous diseases. Hypercalcaemia in the lattermost is classically caused by overproduction of calcitriol by activated macrophages. However, there are case reports of mycobacterial infections with hypercalcaemia despite normal calcitriol levels, supporting the existence of an additional mechanism of hypercalcaemia in granulomatous infections.
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Affiliation(s)
- Robert Costigan Flowers
- University of Miami Health System, Miami, Florida, USA
- Jackson Memorial Hospital, Miami, Florida, USA
| | - Javier Ocampo
- University of Miami Health System, Miami, Florida, USA
- Jackson Memorial Hospital, Miami, Florida, USA
| | - Justin Krautbauer
- University of Miami Health System, Miami, Florida, USA
- Jackson Memorial Hospital, Miami, Florida, USA
| | - Warren L Kupin
- Nephrology and Hypertension, Miami Transplant Institute, Miami, Florida, USA
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2
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Chatterjee T, Reddy YPS, Kandula M. Mycobacterium avium complex: An unusual cause of hypercalcemia. IDCases 2021; 26:e01317. [PMID: 34786338 PMCID: PMC8577481 DOI: 10.1016/j.idcr.2021.e01317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022] Open
Abstract
Mycobacterium avium-complex (MAC) is an infectious granulomatous disease which is associated with hypercalcemia especially in immunocompromised patients. We present an unusual case of MAC infection in an immunocompetent patient presenting as hypercalcemia.A 76-year-old immunocompetent male was admitted for hypercalcemia of 12.6 mg/dl found on outpatient evaluation for fatigue. PTH level was low 8 pmol/L, Vitamin D 25hydroxy was 29 ng/ml, 1,25 dihydroxy vitamin D (1,25(OH)2 vitamin D) levels was low at 11 pg/ml, PTH related peptide was 1.1 pmol/L. Hypercalcemia resolved with intravenous hydration and bisphosphonate administration. CT chest identified a nodule with central cavity in the right upper lobe. Pathology from percutaneous biopsy of thenodule demonstrated granulomatous inflammation. AFB culture came positive for MAC. Patient was treated with Azithromycin, Rifabutin and Ethambutol for twelve months.Granulomatous diseases like MAC cause hypercalcemia via activation of macrophages which express extrarenal 1- alpha -hydroxylase. It converts vitamin D to its active form 1,25(OH)2 vitamin D causing its excess, leading to hypercalcemia. Interestingly, in our patient calcium level was elevated with appropriately low PTH but 1,25(OH)2 vitamin D level was also low. There are few reported cases of hypercalcemia in granulomatous disease with normal levels of 1,25(OH)2 vitamin D levels, and our case is the first one to have MAC associated hypercalcemia with low 1,25(OH)2 vitamin D levels, suggesting an alternative mechanism for hypercalcemia in these patients.
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Affiliation(s)
- Tulika Chatterjee
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | | | - Manasa Kandula
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
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3
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Gwadera Ł, Białas AJ, Iwański MA, Górski P, Piotrowski WJ. Sarcoidosis and calcium homeostasis disturbances-Do we know where we stand? Chron Respir Dis 2020; 16:1479973119878713. [PMID: 31718265 PMCID: PMC6854763 DOI: 10.1177/1479973119878713] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The majority of cases involving hypercalcemia in the setting of sarcoidosis are explained by the overproduction of calcitriol by activated macrophages. Vitamin D takes part in the regulation of granuloma formation. However, using vitamin D metabolites to assess the activity of the disease is still problematic, and its usefulness is disputable. In some cases, though, a calcium metabolism disorder could be a valuable tool (i.e. as a marker of extrathoracic sarcoidosis). Although sarcoidosis does not cause a decrease in bone mineral density, increased incidence of vertebral deformities is noted. Despite increasing knowledge about calcium homeostasis disorders in patients with sarcoidosis, there is still a need for clear guidelines regarding calcium and vitamin D supplementation in these patients.
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Affiliation(s)
- Łukasz Gwadera
- Department of Pneumology and Allergy, Chair of Internal Medicine, Medical University of Lodz, Poland
| | - Adam Jerzy Białas
- Department of Pneumology and Allergy, Chair of Internal Medicine, Medical University of Lodz, Poland
| | | | - Paweł Górski
- Department of Pneumology and Allergy, Chair of Internal Medicine, Medical University of Lodz, Poland
| | - Wojciech Jerzy Piotrowski
- Department of Pneumology and Allergy, Chair of Internal Medicine, Medical University of Lodz, Poland
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Kuthiah N, Chaozer E. Hypercalcaemia secondary to disseminated Mycobacterium abscessus and Mycobacterium fortuitum. J R Coll Physicians Edinb 2019; 49:217-221. [PMID: 31497789 DOI: 10.4997/jrcpe.2019.309] [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: 11/19/2022] Open
Abstract
The incidence and prevalence of nontuberculous mycobacteria (NTM) infection is on the rise with many cases still going unreported. Given the vague and nonspecific clinical features of NTM infections, it is often missed or mistaken for Mycobacterium tuberculosis. The presumption that NTM infections are benign and do not contribute to morbidity no longer holds true. NTM infections need to be considered in patients with disseminated multisystem disease and in those not responding to standard M. tuberculosis treatment. As NTM infection is associated with granuloma formation, it can result in hypercalcaemia. Interestingly, there is evidence that there may be other mechanisms in play contributing to hypercalcaemia besides the increased calcitriol levels.
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Affiliation(s)
- Navin Kuthiah
- WHC Office, Level 5, Tower E, Yishun Community Hospital, 2 Yishun Central 2, 768024, Singapore,
| | - Er Chaozer
- Internal Medicine, Woodlands Health Campus, Yishun, Singapore
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5
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Liu Z, Ding X, Wu J, He H, Wu Z, Xie D, Yang Z, Wang Y, Tian J. Dose-response relationship between higher serum calcium level and higher prevalence of hyperuricemia: A cross-sectional study. Medicine (Baltimore) 2019; 98:e15611. [PMID: 31096467 PMCID: PMC6531036 DOI: 10.1097/md.0000000000015611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The aim of the study was to examine the relationship between serum calcium (Ca) levels and the prevalence of hyperuricemia (HU).The data included in this analysis were extracted from a population-based study conducted at the Xiangya Hospital Health Management Centre. Serum Ca levels were measured using the Arsenazo III method. HU was defined as the uric acid ≥416 μmol/L for male subjects, and ≥360 μmol/L for female subjects. The association between serum Ca levels and the prevalence of HU was evaluated using logistic and spline regression.The present study included a total of 6337 subjects. The overall prevalence of HU for the target population was 17.5%. Compared with the lowest quintile, the odds ratios adjusted by age, sex, body mass index, smoking, and drinking for HU were 1.51 [95% confidence interval (CI): 1.20-1.91], 1.43 (95% CI: 1.13-1.82), 2.02 (95% CI: 1.61-2.54), and 2.54 (95% CI: 2.02-3.18) for the second, third, fourth, and fifth quintiles of serum Ca levels, respectively (P for trend <.001), and a positive dose-response relationship was observed. Similar results were observed for men and women, respectively. The findings were not materially altered by the adjustment for further potential confounders.Subjects with higher serum Ca levels are subject to a higher prevalence of HU in a dose-response relationship manner.
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Affiliation(s)
- Zhichen Liu
- Department of Orthopaedics, Xiangya Hospital
| | - Xiang Ding
- Department of Orthopaedics, Xiangya Hospital
| | - Jing Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hongyi He
- Department of Orthopaedics, Xiangya Hospital
| | - Ziying Wu
- Department of Orthopaedics, Xiangya Hospital
| | | | - Zidan Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital
| | - Jian Tian
- Department of Orthopaedics, Xiangya Hospital
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Abdulfattah O, Rahman EU, Shweta FNU, Datar P, Alnafoosi Z, Trauber D, Sam M, Enriquez D, Schmidt F. Severe hypercalcemia in a patient with extrapulmonary Mycobacterium abscessus: granuloma or immune reconstitution inflammatory syndrome? First case of Mycobacterium abscessus presenting as retroperitoneal lymphadenopathy with severe hypercalcemia: a case report and literature review. J Community Hosp Intern Med Perspect 2018; 8:331-338. [PMID: 30559940 PMCID: PMC6292348 DOI: 10.1080/20009666.2018.1539057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Nontuberculous mycobacterium is a recognized cause of hypercalcemia, particularly in patients with acquired immunodeficiency syndrome (AIDS). Here we describe a case of severe hypercalcemia secondary to Mycobacterium abscessus (M. abscessus) in a patient with AIDS. To the best of our knowledge this is the first case report describing a case of M. abscessus presenting as retroperitoneal lymphadenopathy and severe hypercalcemia. Case description: A 56-year-old man with AIDS presented with altered mental status and somnolence for four days. Laboratory investigations were significant for calcium 16.49 mg/dL (RI 8.9-10.3 mg/dL), 1,25 dihydroxyvitamin D level 44.1 pg/ml (RI 19.9-79.3 pg/ml) and parathyroid hormone (PTH) 4 pg/mL (RI 15-65 pg/mL). CT scan of Abdomen and Pelvis showed hepatosplenomegaly with large retroperitoneal, retrocrural, and mesenteric lymphadenopathy which had an intense focal uptake on Gallium scan. Bone marrow biopsy revealed mild plasmacytosis (5%) with no evidence of myelodysplasia, acute leukemia or lymphoma. A subsequent lymph node biopsy showed fragments of fibrous tissue with lymphohistiocytic infiltrate and many acid-fast bacilli. Pre-antibiotic blood cultures grew Mycobacterium which was identified later as M. abscessus at four weeks. Conclusion: hypercalcemia in HIV-infected patients may suggest malignancy or infectious etiology, among other causes. Clinicians should be aware of the risk of hypercalcemia with nontuberculous mycobacterium (NTM) infection, whether as first manifestation or a late presenter in the disease course after initiating antiretroviral therapy (ART). We suggest careful monitoring of serum calcium level upon diagnosis of NTM infection and after initiation of ART, NTM therapy or vitamin D supplementation.
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Affiliation(s)
- Omar Abdulfattah
- Medicine Department, Pulmonary and Critical Care Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Ebad Ur Rahman
- Medicine Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - FNU Shweta
- Medicine Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - Praveen Datar
- Medicine Department, Pulmonary and Critical Care Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Zainab Alnafoosi
- Medicine Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - David Trauber
- Medicine Department, Hematology/Oncology Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Mirela Sam
- Medicine Department, Infection disease Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Danilo Enriquez
- Medicine Department, Pulmonary and Critical Care Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Frances Schmidt
- Medicine Department, Pulmonary and Critical Care Division, Interfaith Medical Center, Brooklyn, NY, USA
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Xue J, Wang Y, Zheng Y, Zhang J, Qi F, Cheng H, Si S, Li R, Li X, Qin Z, Yu B, Zou Q. Efficacy characteristics of different therapeutic modalities for locally advanced prostate cancer: a Bayesian network meta-analysis of randomized controlled trials. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:358. [PMID: 30370285 DOI: 10.21037/atm.2018.08.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Though previous studies have investigated the efficacy characteristics of several different therapeutic modalities for locally advanced prostate cancer (LAPCa) patients, the available results remained unestablished. Therefore, the aim of this meta-analysis was conducted to clarify such differences. Methods The online PubMed, EMBASE and Web of Science were comprehensively searched for relevant studies published before September 1st, 2017, and eventually eleven relevant studies met the inclusion criteria. The hazard odds ratios (HRs) with 95% credible interval (CI) were utilized to evaluate the efficacy characteristics of several different therapeutic modalities for LAPCa patients by Markov chain Monte Carlo methods. Results Five different therapeutic modalities were ultimately enrolled to shed light on the efficacy characteristics for LAPCa patients and seven different clinical outcomes were finally analyzed in this study. The cumulative rank probability of overall survival (OS) or cancer-specific survival (CSS) from best to worst was radiotherapy (RT) + orchiectomy, RT + long-term androgen deprivation therapy (LTADT), RT + short-term androgen deprivation therapy (STADT), LTADT and RT; RT + LTADT, RT + orchiectomy, RT + STADT, LTADT and RT, respectively. Meanwhile, in the terms of progression-free survival (PFS), biochemical failure rate (BFR), disease-free survival (DFS), local progression rate (LPR) and metastasis rate (MR), RT + LTADT as well as RT + STADT had a higher, whereas RT alone or LTADT had a relatively lower treatment effect. Conclusions All in all, our results indicated that RT + LTADT or RT + orchiectomy was among the best two therapeutic regimens in the prognostic aspects of the patients with LAPCa. Furthermore, in consideration of reducing invasive treatment of eligible patients, RT + LTADT could yield better survival benefit of LAPCa patients, compared with others. In addition, the results of our analysis might provide a reference in the clinical selection. Larger sample sizes of strictly designed randomised controlled trials (RCTs) were wanted to validate our findings.
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Affiliation(s)
- Jianxin Xue
- Department of Urology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, China.,Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yi Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuxiao Zheng
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, China
| | - Jianzhong Zhang
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Feng Qi
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hong Cheng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Shuhui Si
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ran Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiao Li
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, China
| | - Zhiqiang Qin
- Department of Urology and Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Bin Yu
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, China
| | - Qing Zou
- Department of Urologic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, China
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Parsons CE, Singh S, Geyer HL. A case of hypercalcaemia in an immunocompetent patient with Mycobacterium avium intracellulare. JRSM Open 2017; 8:2054270417716614. [PMID: 28748100 PMCID: PMC5507386 DOI: 10.1177/2054270417716614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mycobacterium avium intracellulare infection or colonization should be considered in the differential diagnosis of hypercalcemia, especially in immunocompromised individuals, in the appropriate clinical context.
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Affiliation(s)
| | - Sujata Singh
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Holly L Geyer
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
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9
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Abstract
Hypercalcemia occurs in up to 4% of the population in association with malignancy, primary hyperparathyroidism, ingestion of excessive calcium and/or vitamin D, ectopic production of 1,25-dihydroxyvitamin D [1,25(OH)2D], and impaired degradation of 1,25(OH)2D. The ingestion of excessive amounts of vitamin D3 (or vitamin D2) results in hypercalcemia and hypercalciuria due to the formation of supraphysiological amounts of 25-hydroxyvitamin D [25(OH)D] that bind to the vitamin D receptor, albeit with lower affinity than the active form of the vitamin, 1,25(OH)2D, and the formation of 5,6-trans 25(OH)D, which binds to the vitamin D receptor more tightly than 25(OH)D. In patients with granulomatous disease such as sarcoidosis or tuberculosis and tumors such as lymphomas, hypercalcemia occurs as a result of the activity of ectopic 25(OH)D-1-hydroxylase (CYP27B1) expressed in macrophages or tumor cells and the formation of excessive amounts of 1,25(OH)2D. Recent work has identified a novel cause of non-PTH-mediated hypercalcemia that occurs when the degradation of 1,25(OH)2D is impaired as a result of mutations of the 1,25(OH)2D-24-hydroxylase cytochrome P450 (CYP24A1). Patients with biallelic and, in some instances, monoallelic mutations of the CYP24A1 gene have elevated serum calcium concentrations associated with elevated serum 1,25(OH)2D, suppressed PTH concentrations, hypercalciuria, nephrocalcinosis, nephrolithiasis, and on occasion, reduced bone density. Of interest, first-time calcium renal stone formers have elevated 1,25(OH)2D and evidence of impaired 24-hydroxylase-mediated 1,25(OH)2D degradation. We will describe the biochemical processes associated with the synthesis and degradation of various vitamin D metabolites, the clinical features of the vitamin D-mediated hypercalcemia, their biochemical diagnosis, and treatment.
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Affiliation(s)
- Peter J Tebben
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Ravinder J Singh
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Rajiv Kumar
- Divisions of Endocrinology (P.J.T., R.K.) and Nephrology and Hypertension (R.K.), and Departments of Pediatric and Adolescent Medicine (P.J.T.), Internal Medicine (P.J.T., R.K.), Laboratory Medicine and Pathology (R.J.S.), and Biochemistry in Molecular Biology (R.K.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905
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Mycobacterium avium-intracellulare and the unpredictable course of hypercalcemia in an AIDS patient. Braz J Infect Dis 2016; 21:116-118. [PMID: 27620657 PMCID: PMC9425548 DOI: 10.1016/j.bjid.2016.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/01/2016] [Indexed: 11/21/2022] Open
Abstract
A 37-year-old man with AIDS presented with altered mental status four weeks after stopping his medications for Mycobacterium avium-intracellulare (MAI). He had low CD4 cell count and severe hypercalcemia. Bone marrow biopsy revealed bone marrow infiltration by granulomas positive for acid-fast bacilli and cultures grew MAI. His hypercalcemia continued to worsen with the initiation of MAI therapy but we were able to treat it successfully with pamidronate and calcitonin.
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Rados DV, Furlanetto TW. An unexpected cause of severe and refractory PTH-independent hypercalcemia: case report and literature review. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 59:277-80. [PMID: 26154099 DOI: 10.1590/2359-3997000000051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/20/2015] [Indexed: 11/22/2022]
Abstract
Hypercalcemia is a common condition in the internal medicine practice. Sometimes its cause is not readily apparent, so extensive investigation is appropriate. Here we report an unexpected cause for hypercalcemia in an elderly woman. The case of an 82-years old woman with PTH-independent hypercalcemia, lymphocytosis, normal serum 1,25 (OH)vitamin D levels, and low serum PTHrp levels, is described. Medical history and complementary investigation were unremarkable, except for increased metabolic activity in the glutei regions, as measured by whole body 18F-FDG PET-CT. Reviewing her medical history, her sister recalled that she had been submitted to intramuscular methylmethacrylate injections, for cosmetic purposes, five years before presentation, which was confirmed by muscle biopsy. Low calcium intake, parenteral bisphosphonates, calcitonin, and glucocorticoids were used to control serum calcium levels. Methylmethacrylate injections, used cosmetically, are a new cause for hypercalcemia, even after many years. Hypercalcemia was probably due to calcitriol overproduction in foreign body granulomas. Persistent reactive lymphocytosis could be a clue for this inflammatory cause of hypercalcemia.
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Affiliation(s)
- Dimitris Varvaki Rados
- Internal Medicine Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Tania Weber Furlanetto
- Internal Medicine Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
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Foss NT, Motta ACF. Leprosy, a neglected disease that causes a wide variety of clinical conditions in tropical countries. Mem Inst Oswaldo Cruz 2012; 107 Suppl 1:28-33. [DOI: 10.1590/s0074-02762012000900006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/14/2012] [Indexed: 11/22/2022] Open
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Hypercalcemia in Human Immunodeficiency Virus-Related Lymphoma and Valacyclovir Toxicity. Am J Med Sci 2011; 342:539. [DOI: 10.1097/maj.0b013e31823ac66f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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