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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

Lung peribronchial tissue on high power (×400) showing nonnecrotizing granuloma comprised mainly of multinucleated giant cells (black arrows) and epithelioid cells. The background shows ciliated pseudostratified columnar epithelium (Hematoxylin and Eosin stain).
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fig4: Lung peribronchial tissue on high power (×400) showing nonnecrotizing granuloma comprised mainly of multinucleated giant cells (black arrows) and epithelioid cells. The background shows ciliated pseudostratified columnar epithelium (Hematoxylin and Eosin stain).

Mentions: Patient underwent Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial and endobronchial biopsies. Transbronchial biopsy showed nonnecrotizing granulomatous inflammation consistent with sarcoidosis (Figure 4). The patient was started on prednisone. After receiving therapy with prednisone and hydration the calcium levels decreased and remained stable between 12 mg/dL (3.0 mmol/L) and 12.5 mg/dL (3.13 mmol/L). Renal function and anemia level returned to baseline after receiving starting prednisone and the patient was subsequently discharged to skilled nursing facility on prednisone.


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)

Lung peribronchial tissue on high power (×400) showing nonnecrotizing granuloma comprised mainly of multinucleated giant cells (black arrows) and epithelioid cells. The background shows ciliated pseudostratified columnar epithelium (Hematoxylin and Eosin stain).
© Copyright Policy
Related In: Results  -  Collection

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

fig4: Lung peribronchial tissue on high power (×400) showing nonnecrotizing granuloma comprised mainly of multinucleated giant cells (black arrows) and epithelioid cells. The background shows ciliated pseudostratified columnar epithelium (Hematoxylin and Eosin stain).
Mentions: Patient underwent Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial and endobronchial biopsies. Transbronchial biopsy showed nonnecrotizing granulomatous inflammation consistent with sarcoidosis (Figure 4). The patient was started on prednisone. After receiving therapy with prednisone and hydration the calcium levels decreased and remained stable between 12 mg/dL (3.0 mmol/L) and 12.5 mg/dL (3.13 mmol/L). Renal function and anemia level returned to baseline after receiving starting prednisone and the patient was subsequently discharged to skilled nursing facility on prednisone.

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