Elevated Cytokine Levels in a Patient with AIDS and Hypercalcemia: Effects of Therapy with Pamidronate

Carbone, Laura D.; Land, Mack A.; Stentz, Frankie B.; Palmieri, Genaro M. A.

doi:10.1093/clinids/21.3.699

Cited by 7 publications

(4 citation statements)

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“…Hypercalcemia in CMV disease is thought to result from direct osteoclastic activation by activated T cells or proinflammatory cytokines (35,36) . Carbone et al reported a patient with AIDS‐related hypercalcemia of unknown origin but with increased levels of TNF‐α, IL‐6, and IL‐8, and serum calcium levels normalized after treatment with pamidronate (42) . Hypercalcemia in protozoal, fungal, and mycobacterial infection may result from extrarenal 1α‐hydroxylation of 25‐hydroxyvitamin D 3 [25(OH)D 3 ] by macrophages, monocytes, epithelioid cells, and multinucleated giant cells (37–41) .…”

Section: Calcium Homeostasis In Hiv Infectionmentioning

confidence: 99%

Bone and Mineral Metabolism in Human Immunodeficiency Virus Infection

Kühne

Heufelder

Hofbauer

2001

Journal of Bone and Mineral Research

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Section: Calcium Homeostasis In Hiv Infectionmentioning

confidence: 99%

Bone and Mineral Metabolism in Human Immunodeficiency Virus Infection

Kühne

Heufelder

Hofbauer

2001

Journal of Bone and Mineral Research

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“…We were unable, however, to demonstrate an elevation in the serum 1,25‐dihydroxy vitamin D level, making the mechanism of hypercalcaemia uncertain. Other cases have been reported in which elevated vitamin D metabolites could not be demonstrated in the setting of hypercalcaemia accompanying granulomatous disease, suggesting there may be alternative mechanisms 11,12 . One study found elevated serum levels of tumour necrosis factor‐α and interleukin‐6, which have also been associated with hypercalcaemia complicating malignancy 12 …”

Section: Discussionmentioning

confidence: 99%

“…Other cases have been reported in which elevated vitamin D metabolites could not be demonstrated in the setting of hypercalcaemia accompanying granulomatous disease, suggesting there may be alternative mechanisms. "• 12 One study found elevated serum levels of tumour necrosis factor-a and interleukin-6, which have also been associated with hypercalcaemia complicating malignancy. 12 Regardless of the mechanism of the hypercalcaemia in our case, it proved to be the first clue to a significant systemic atypical mycobacterial infection.…”

Section: Discussionmentioning

confidence: 99%

“…"• 12 One study found elevated serum levels of tumour necrosis factor-a and interleukin-6, which have also been associated with hypercalcaemia complicating malignancy. 12 Regardless of the mechanism of the hypercalcaemia in our case, it proved to be the first clue to a significant systemic atypical mycobacterial infection. Patients infected with HIV who develop hypercalcaemia should be closely evaluated for these infections.…”

Section: Discussionmentioning

confidence: 99%

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HYPERCALCAEMIA: A CLUE TO MYCOBACTERIUM AVIUM INTRACELLULARE INFECTION IN A PATIENT WITH AIDS

Aly

Baig

Khanna

et al. 1999

Int J Clinical Practice

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SUMMARYHypercalcaemia is uncommon in HIV‐infected patients and should suggest a different priority for differential diagnosis than would be considered in other settings. Although hypercalcaemia has long been associated with granulomatous diseases including tuberculosis, it has only recently been recognised that patients with illness due to Mycobacterium avium intracellulars (MAI) may develop it. We report a patient with AIDS in whom unexplained hypercalcaemia was the harbinger of clinically significant MAI infection. Patients with AIDS who develop hypercalcaemia should be closely evaluated for underlying MAI infection.

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Hypercalcemia and systemic lupus erythematosus

Deftos

Burton

Baird

et al. 1996

Arthritis & Rheumatism

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Hypercalcemia is commonly caused by the increased production of parathyroid hormone-related protein (PTHrP) by a malignancy. In fact, the demonstration of increased PTHrP production in a patient with hypercalcemia is virtually pathognomonic of malignancy. We studied a patient with systemic lupus erythematosus (SLE), generalized lymphadenopathy, and hypercalcemia. Immunohistology of 2 biopsied lymph nodes revealed the abundant expression of PTHrP and the absence of malignant transformation. Although apparently rare, PTHrP production by nonmalignant lymphoid tissue may occur in SLE and should be considered in the differential diagnosis of hypercalcemia.Malignancy ranks among the leading considerations in the differential diagnosis of hypercalcemia and, overall, ranks comparably with primary hyperparathyroidism as the cause of hypercalcemia (1). Hypercalcemia as a paraneoplastic phenomenon was first described in the 1930s in patients with a variety of carcinomas and no detectable parathyroid abnormality (2). Since its discovery, parathyroid hormone-related protein (PTHrP) has been implicated in the pathogenesis of the hypercalcemia associated with a wide variety of tumors (3). In fact, hypercalcemia resulting from PTHrP secretion has been essentially pathognomonic for malignancy (3-5). Hypercalcemia appears to be rare as a primary manifestation of systemic lupus erythematosus (SLE). We report herein a patient with SLE in whom severe hypercalcemia developed in association with abundant PTHrP expression by nonmalignant lymph nodes. CASE REPORTThe patient, a 29-year-old African-American male, presented in July 1995 with hypercalcemia associated with weakness and fatigue of 3 days' duration. Two years prior to admission, he developed proteinuria of 0.9 gm/24 hours and a mild persistent elevation in the serum creatinine value of 1.5-1.9 mg/dl, with positive antinuclear antibodies (titer >1:640, speckled pattern), normal C3 and C4 levels, and negative hepatitis B surface antigen. Serum protein electrophoresis revealed polyclonal hypergammaglobulinemia.Three days before admission, he noted anorexia and fatigue. His symptoms progressed to include lightheadedness, generalized weakness, and a 10-pound weight loss. Medications at the time of admission were oral verapamil 180 mgJday and 1-2 multivitamins (containing 400 IU of vitamin D) daily. The patient had discontinued a thiazide diuretic 3 weeks prior to admission.Physical examination revealed a well-developed male with normal vital signs, except for a temperature of 99.3"F orally. Diffuse lymphadenopathy was present, involving small cervical, inguinal, and axillary nodes, which were mobile and nontender bilaterally. The spleen tip was palpable. A macular hyperpigmented rash was noted on the lower extremities.The serum calcium level on admission was 13.8 mg/dl (normal 8.4-10.2), reaching as high as 14.4 mg/dl, ionized calcium was 1.94 mg/dl (normal 1.1-1.35), and phosphorus was 4.8 mg/dl (normal 2.4-4.5). The serum PTH value was <4 pdml (normal 0-200). Serum PTHrP was und...

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Elevated Cytokine Levels in a Patient with AIDS and Hypercalcemia: Effects of Therapy with Pamidronate

Cited by 7 publications

References 0 publications

Bone and Mineral Metabolism in Human Immunodeficiency Virus Infection

Bone and Mineral Metabolism in Human Immunodeficiency Virus Infection

HYPERCALCAEMIA: A CLUE TO MYCOBACTERIUM AVIUM INTRACELLULARE INFECTION IN A PATIENT WITH AIDS

Hypercalcemia and systemic lupus erythematosus

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