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Hypercalcemia, Anemia, and Acute Kidney Injury: A Rare Presentation of Sarcoidosis.

Sharma N, Tariq H, Uday K, Skaradinskiy Y, Niazi M, Chilimuri S - Case Rep Med (2015)

Bottom Line: The chest X-ray did not reveal any pathology.Noncontrast computed tomography (CT) scan of chest showed bilateral apical bronchiectasis, but did not show any lymphadenopathy or evidence of malignancy.Subsequently, a fiber optic bronchoscopy with transbronchial biopsy showed nonnecrotizing granulomatous inflammation consistent with sarcoidosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 10C, Bronx, NY 10457, USA.

ABSTRACT
We discuss a case of a 61-year-old woman who presented with substernal chest pain. She was found to have elevated calcium levels, anemia, and acute kidney injury. The hypercalcemia persisted despite therapy with fluids and bisphosphonates. She was found to have nonparathyroid hormone (PTH) mediated hypercalcemia. The chest X-ray did not reveal any pathology. Our Initial impression was likely underlying hematologic malignancy such as lymphoma or multiple myeloma. A bone marrow biopsy was performed that revealed nonnecrotizing granulomatous inflammation. Further workup revealed elevated vitamin 1,25 dihydroxy level, beta-two microglobulin level, and ACE levels. Noncontrast computed tomography (CT) scan of chest showed bilateral apical bronchiectasis, but did not show any lymphadenopathy or evidence of malignancy. Subsequently, a fiber optic bronchoscopy with transbronchial biopsy showed nonnecrotizing granulomatous inflammation consistent with sarcoidosis. After initiating glucocorticoid therapy, the patient's hypercalcemia improved and her kidney function returned to baseline.

No MeSH data available.


Related in: MedlinePlus

Serum calcium levels during hospitalization.
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fig1: Serum calcium levels during hospitalization.

Mentions: The patient was initially managed in the medical intensive care unit with intravenous fluids and pamidronate. The serum calcium slowly decreased from 16.6 mg/dL (4.15 mmol/L) to 10.6 mg/dL (2.65 mmol/L). Figure 1 shows the serum calcium trend during the hospitalization. The renal function improved from serum creatinine of 3.8 mg/dL (335 umol/L) to 2.5 mg/dL (221 umol/L).


Hypercalcemia, Anemia, and Acute Kidney Injury: A Rare Presentation of Sarcoidosis.

Sharma N, Tariq H, Uday K, Skaradinskiy Y, Niazi M, Chilimuri S - Case Rep Med (2015)

Serum calcium levels during hospitalization.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493310&req=5

fig1: Serum calcium levels during hospitalization.
Mentions: The patient was initially managed in the medical intensive care unit with intravenous fluids and pamidronate. The serum calcium slowly decreased from 16.6 mg/dL (4.15 mmol/L) to 10.6 mg/dL (2.65 mmol/L). Figure 1 shows the serum calcium trend during the hospitalization. The renal function improved from serum creatinine of 3.8 mg/dL (335 umol/L) to 2.5 mg/dL (221 umol/L).

Bottom Line: The chest X-ray did not reveal any pathology.Noncontrast computed tomography (CT) scan of chest showed bilateral apical bronchiectasis, but did not show any lymphadenopathy or evidence of malignancy.Subsequently, a fiber optic bronchoscopy with transbronchial biopsy showed nonnecrotizing granulomatous inflammation consistent with sarcoidosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 10C, Bronx, NY 10457, USA.

ABSTRACT
We discuss a case of a 61-year-old woman who presented with substernal chest pain. She was found to have elevated calcium levels, anemia, and acute kidney injury. The hypercalcemia persisted despite therapy with fluids and bisphosphonates. She was found to have nonparathyroid hormone (PTH) mediated hypercalcemia. The chest X-ray did not reveal any pathology. Our Initial impression was likely underlying hematologic malignancy such as lymphoma or multiple myeloma. A bone marrow biopsy was performed that revealed nonnecrotizing granulomatous inflammation. Further workup revealed elevated vitamin 1,25 dihydroxy level, beta-two microglobulin level, and ACE levels. Noncontrast computed tomography (CT) scan of chest showed bilateral apical bronchiectasis, but did not show any lymphadenopathy or evidence of malignancy. Subsequently, a fiber optic bronchoscopy with transbronchial biopsy showed nonnecrotizing granulomatous inflammation consistent with sarcoidosis. After initiating glucocorticoid therapy, the patient's hypercalcemia improved and her kidney function returned to baseline.

No MeSH data available.


Related in: MedlinePlus