Studies of the Hypercalcaemia of Sarcoidosis: Effect of Steroids and Exogenous Vitamin D&lt;sub&gt;3&lt;/sub&gt; on the Circulating Concentrations of 1, 25-Dihydroxy Vitamin D&lt;sub&gt;3&lt;/sub&gt;

Hypercalcemia in human immunodeficiency virus (HIV) patients can be challenging due to various underlying mechanisms. 1,25- dihydroxycholecalciferol (1,25 (OH)2 vitamin D)-mediated hypercalcemia due to increased activity of extrarenal 1-alpha hydroxylase is one of the well-known mechanisms of hypercalcemia described in HIV patients. Mycobacterium avium-intracellulare (MAI) is a granulomatous disease that can cause hypercalcemia due to ectopic production of alpha -1 hydroxylase and result in increased levels of 1,25 (OH)2 vitamin D. Herein, we present a case of “late-onset” hypercalcemia in a patient with HIV/AIDS and MAI infection in the setting of suspected immune reconstitution inflammatory syndrome (IRIS). The hypercalcemia workup showed an inappropriately average level of 1,25 (OH)2 vitamin D while the rest of the workup was unrevealing. Unusually normal levels of vitamin D metabolites were the driving mechanism of hypercalcemia in this case. The late presentation of hypercalcemia was likely due to IRIS unmasking an underlying granulomatous infection, and this consideration led to the successful treatment of the patient with steroid administration. This case emphasizes the importance of considering IRIS in evaluating hypercalcemia that presents late in the course of granulomatous infections in HIV patients.

Section: Discussionmentioning

confidence: 99%

Late Onset Hypercalcemia in an HIV Patient as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS)

Zatreh,

Drees,

Shah

2024

“…Glucocorticoids are also part of the management of hypercalcemia, especially when it is secondary to lymphomas and granulomatous diseases. They decrease the intestinal absorption of calcium by reducing the synthesis of 1,25(OH)2D and increasing urinary calcium excretion [8].…”

Section: Discussionmentioning

confidence: 99%

Double Trouble: A Unique Case of Hypercalcemia Caused by Two Underlying Etiologies

Ordaya¹,

Arriola-Montenegro²,

Arriola-Montenegro³

et al. 2022

Hypercalcemia has a variety of causes, with primary hyperparathyroidism and malignancies being the most frequently reported. We present the case of a patient presenting with chronic abdominal pain, constipation, and weight loss who was found to have hypercalcemia. The patient was initially diagnosed with colonic actinomycosis, but further investigations revealed an intra-abdominal diffuse large B-cell lymphoma (DLBCL). We suspect that the leading cause of hypercalcemia was the DLBCL, likely exacerbated by actinomycosis. Actinomycosis and DLBCL can have a similar presentation, so misdiagnosis or coexistence of both conditions should be suspected when a lack of response to one specific therapy is observed.

“…Tachyphylaxis develops quickly. Corticosteroids are particularly effective in hypercalcemia due to granulomatous diseases such as sarcoidosis because they inhibit the abnormal production of calcitriol [42]. Recalcitrant hypercalcemia, especially in patients with acute kidney injury or advanced CKD, will respond to hemodialysis utilizing a low Ca +2 dialysate bath of ≤2 mEq/l [43].…”

Section: Managementmentioning

confidence: 99%

Disorders of Calcium Metabolism: Hypocalcemia and Hypercalcemia

Tinawi

2021

Calcium (Ca +2 ) is a divalent cation that plays a critical role in numerous body functions such as skeletal mineralization, signal transduction, nerve conduction, muscle contraction, and blood coagulation. Ca +2 metabolism is linked to magnesium (Mg +2 ) and phosphate metabolism. Ca +2 homeostasis is dependent on intestinal absorption, bone turnover, and renal reabsorption. The hormonal regulators of these processes are the parathyroid hormone (PTH), calcitriol {1,25-dihydroxyvitamin D [1,25(OH) 2 D]}, and serum ionized Ca +2 . Cloning of the Ca +2 -sensing receptor (CaSR) has greatly advanced the understanding of Ca +2 metabolism. Disorders of Ca +2 metabolism are easily recognized because Ca +2 is included in routine chemistry panels. Measurement of ionized Ca +2 is the preferred way to ascertain the diagnosis of hypocalcemia and hypercalcemia.