Calcitriol-induced hypercalcemia in a patient with granulomatous mycosis fungoides and end-stage renal disease

Abstract

An 86-year-old man, diagnosed as having mycosis fungoides in May 2008 and treated with repeated radiation therapy, was admitted to our hospital for initiation of hemodialysis due to end-stage renal disease (ESRD) in April 2012. On admission, his corrected serum calcium level was 9.3 mg/dL, and his intact parathyroid hormone level was 121.9 pg/mL (normal range 13.9-78.5 pg/mL), indicating secondary hyperparathyroidism due to ESRD. After starting hemodialysis, urinary volume diminished rapidly. The serum calcium level increased (12.7 mg/dL), and the intact parathyroid hormone level was suppressed (< 5 pg/mL), while the 1,25-dihydroxyvitamin D3 (calcitriol) level increased (114 pg/mL, normal range: 20.0-60.0 pg/mL) in June 2012. The possibilities of sarcoidosis and tuberculosis were ruled out. Skin biopsies from tumorous lesions revealed a diagnosis of granulomatous mycosis fungoides. The serum soluble interleukin-2 receptor levels and the degrees of skin lesions went in parallel with the increased serum calcium and calcitriol levels. Therefore, the patient was diagnosed as having calcitriol-induced hypercalcemia possibly associated with granulomatous mycosis fungoides. Granulomatous mycosis fungoides is rare, and its association with calcitriol-induced hypercalcemia has not been reported. Careful attention to calcium metabolism is needed in patients with granulomatous mycosis fungoides, especially in patients with ESRD.

Risk factors of different mortality periods in older patients with end-stage renal disease undergoing urgent-start peritoneal dialysis: a retrospective observational study

“…We reached a similar conclusion that older patients with a higher baseline calcium level were at increased risk of mortality after 6 months of USPD therapy. The occurrence of secondary hyperparathyroidism, exogenous calcium supplementation, use of calcium-containing phosphorus-binding agents, and the possible presence of granulomatous mycosis fungoides (rare) in patients with ESRD contribute to the development of baseline higher calcium level [ 45 , 46 ], and as PD proceeds, the use of high-calcium dialysate may exacerbate hypercalcemia by increasing the influx of calcium into the extracellular fluid [ 45 ]. Some of the above-mentioned factors contributing to increased serum calcium levels and calcification can be corrected by using low-calcium peritoneal dialysate and limiting the usage of calcium-containing phosphate binders [ 47 , 48 ].…”