We recently encountered two patients with coexistent hyperparathyrodism and sarcoidosis presenting with hypercalcaemia. The association between hypercalcaemic primary hyperparathyroidism and sarcoidosis is reviewed.
Dear Editor,Scleroderma renal crisis (SRC) is an uncommon complication of systemic sclerosis that presents with malignant hypertension and oliguric renal failure. However, 10% of SRC cases are normotensive, 1 which are typically associated with prior use of angiotensin converting enzyme inhibitors (ACE-I), calcium channel blockers and in patients with myocardial involvement. 1 For some patients with normotensive SRC, initial blood pressure is relatively higher compared to baseline levels, although these levels could fall well within the normal limits of blood pressure. A high index of suspicion is therefore necessary to identify high-risk patients who may benefit from early treatment. Case PresentationA 66-year-old Chinese man presented to the Emergency Department with vomiting and non-bloody diarrhoea for two days. Blood pressure was 127/77 mm Hg and heart rate was 70 beats per minute. His baseline blood pressure was 106/57 mmHg.He was diagnosed with diffuse cutaneous systemic sclerosis 3 months earlier following an initial presentation of rapidly worsening diffuse cutaneous thickening, Raynaud phenomenon and gastroesophageal reflux. His medications included oral nifedipine, omeprazole and domperidone. Two weeks prior to his current presentation, he received oral prednisolone and intravenous cyclophosphamide 700 mg for non-specific interstitial pneumonitis.Antinuclear screen was reported as positive but its titre and staining pattern was not performed. Anti-Ro and anti-La were positive. Anti-RNA polymerase III antibody and anti-ds DNA were negative.Transthoracic echocardiogram (ECG) showed grade 1 left ventricle diastolic dysfunction and pulmonary hypertension with estimated pulmonary artery systolic pressure of 41 mmHg. Otherwise, heart valves and ventricular function were normal. Left ventricle ejection fraction was 60%. There were no regional wall motion abnormalities. Dobutamine stress ECG was negative for inducible ischaemia. ECG showed normal sinus rhythm.He was treated for infective gastroenteritis with ceftriaxone and metronidazole. His vomiting and diarrhoea resolved within a day. However, his acute kidney injury
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