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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

Bone marrow on high power (×400) with well-formed nonnecrotizing granuloma (black arrow) comprised of epithelioid cells, multinucleated giant cells, scant lymphocytes, and no necrosis (Hematoxylin and Eosin stain).
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fig3: Bone marrow on high power (×400) with well-formed nonnecrotizing granuloma (black arrow) comprised of epithelioid cells, multinucleated giant cells, scant lymphocytes, and no necrosis (Hematoxylin and Eosin stain).

Mentions: PTH-related peptide was elevated at 45 pg/mL. It was possible that this might have been a false positive because at the time of collection patient had GFR of 12 and serum creatinine of 3.9 mg/dL and PTH-related peptide can be elevated in renal disease. Considering the elevated PTH-related peptide levels, a CT scan of the chest, abdomen, and pelvis without contrast was done which showed upper lobe bronchiectasis and a hypodense 4 cm lesion in left kidney. However, there was no evidence of any malignancy, lymphadenopathy, or splenomegaly. Our initial impression was likely multiple myeloma for which protein electrophoresis was done which revealed a normal serum protein electrophoresis and a urine protein electrophoresis that showed a restriction band. A bone marrow biopsy was performed which revealed nonnecrotizing granulomas (Figures 2 and 3). Additional lab tests showed elevated serum ACE level (113 U/L) and beta-2-microglobulin (14.3 mg/L). Sputum for acid fast bacilli AFBs was sent and tuberculosis (TB) was ruled out.


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)

Bone marrow on high power (×400) with well-formed nonnecrotizing granuloma (black arrow) comprised of epithelioid cells, multinucleated giant cells, scant lymphocytes, and no necrosis (Hematoxylin and Eosin stain).
© Copyright Policy
Related In: Results  -  Collection

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

fig3: Bone marrow on high power (×400) with well-formed nonnecrotizing granuloma (black arrow) comprised of epithelioid cells, multinucleated giant cells, scant lymphocytes, and no necrosis (Hematoxylin and Eosin stain).
Mentions: PTH-related peptide was elevated at 45 pg/mL. It was possible that this might have been a false positive because at the time of collection patient had GFR of 12 and serum creatinine of 3.9 mg/dL and PTH-related peptide can be elevated in renal disease. Considering the elevated PTH-related peptide levels, a CT scan of the chest, abdomen, and pelvis without contrast was done which showed upper lobe bronchiectasis and a hypodense 4 cm lesion in left kidney. However, there was no evidence of any malignancy, lymphadenopathy, or splenomegaly. Our initial impression was likely multiple myeloma for which protein electrophoresis was done which revealed a normal serum protein electrophoresis and a urine protein electrophoresis that showed a restriction band. A bone marrow biopsy was performed which revealed nonnecrotizing granulomas (Figures 2 and 3). Additional lab tests showed elevated serum ACE level (113 U/L) and beta-2-microglobulin (14.3 mg/L). Sputum for acid fast bacilli AFBs was sent and tuberculosis (TB) was ruled out.

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