Hypercalsemiain 32 Y Old Man With Sarcoidosis and Paraplegia

Year 2019, Volume: 10 Issue: 3, 68 - 71, 01.07.2019

Vahideh Sadra Fatemeh Ghorbani Mostafa Najafipour Farzad Najafipour

https://doi.org/10.33706/jemcr.609071

Abstract

lntroduction:  Hypercalcemia  of  immobilization  is rare,  but  hypercalciuria is more  common  than  hypercalcemia. Hypercalcemia an uncommon presentation of sarcoidosis occ urs in 5 to 10% of patients, but 30 to 50% has hypercalciuria. The cause of hypercalcemia in sarcoidosis is similar to  other granulomatous  diseases, and increased activity of 1 alpha  hydroxylase.

Case report: A 32-year-old man with a history of car accident and severe trauma to lumbar spine. High serum calcium was reported (14.6 mg/ dl ) in his laboratory data. Chest computed tomography (CT) scan revealed numerous nodules in parenchyma of both lungs. Chronic non-caseating granulomatous inflammation (more probabyl sarcoidosis) was reported. Predniso lonewas started at adose of 35 mg/ day and 10 days after treatment serum calcium level decreased to normal range.

Conclusion: Hypercalcemia has been described in patients with granulomatous disorders, most commonly sarcoidosis. Treatm ent of the hypercalcemia or hypercalciuria in granulomatous disorders is aimed at treatment of the underlying disorder. Moderate -dose glucocorticoid therapyis typically used to treat sarcoidosis. The serum calcium concentration begins to fail in two days, but the full hypocalcemic respo nse may take 7to 10 days depending upon the prednisone dose.

Keywords

hypercalsemia, immobilization, sarcoidosis

References

• 1. Jeny F, Bouvry D, Freynet O, Soussan M, Brauner M, Planes C, et al. Management of sarcoidosis in clinical practice. European Respiratory Review. 2016; 25(140): 141-50.
• 2. Cano-Torres EA, Gonzalez-Cantu A, Hinojosa-Garza G, Castilleja­ Leal F. lmmobilization induced hypercalcemia. Clinical (ases in Mineral and Bone Metabolism. 2016; 13(1): 46.
• 3. Hauser GJ, Gale AD, Fields Al. lmmobilization hypercalcemia : unusual presentation with seizures. Pediatric emergency care. 1989; 5(2): 105-7.
• 4. Horwitz MJ, Hodak SP, Stewart AF. Non-parathyroid hypercalcemai . in Clifford J. Resen MD, Editor. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 7th ed. American Society for Bone and Mineral Research: Washington, DC. 2009. p. 307-12.
• 5. Dubaniewicz A. The diagnostic algorithm of practice in pulmonary and extrapulmonary sarcoidosis. Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego. 2018; 44(261): 101-9.
• 6. Govender P, Serman JS. The diagnosis of sarcoidosis . Clinics in chest medicine. 2015; 36(4): 585-602.
• 7. Judson MA, Thompson BW, Rabin DL, Steimel J, Knattereud GL, Lackland DT, et al. The diagnostic pathwayto sarcoidosis. Chest. 2003; 123(2): 406-12.
• 8. Carroll MF, Schade DS. A practical approach to hypercalcemia. American family physician. 2003; 67(9): 1959 -66.
• 9. Tebben PJ, Singh RJ, Kumar R. Vitamin D-mediated hypercalcemia: mechanisms, diagnosis, and treatment. Endocrine reviews. 2016; 37(5): 521-47.
• 10. Mana J, Rubio-Rivas M, Villalba N, Marcoval J, lriarte A, Molina­ Molina M, et al. Multidisciplinary approach and long-term follow-up in a series of 640 consecutive patients with sarcoidosis: Cohort study of a 40-year clinical experience at a tertiary referral center in Barcelona, Spain. Medicine . 2017; 96(29): e7595.