Open AccessCalcitriol-induced hypercalcemia in a patient with granulomatous mycosis fungoides and end-stage renal disease
Author(s) -
Takamasa Iwakura,
Naro Ohashi,
Naoko Tsuji,
Yasuhisa Naito,
Shinsuke Isobe,
Masafumi Ono,
Tomoyuki Fujikura,
Takayuki Tsuji,
Yukitoshi Sakao,
Hideo Yasuda,
Akihiko Kato,
Toshiharu Fujiyama,
Y. Tokura,
Yoshihide Fujigaki
Publication year - 2013
Publication title -
world journal of nephrology
Language(s) - English
Resource type - Journals
ISSN - 2220-6124
DOI - 10.5527/wjn.v2.i2.44
Subject(s) - mycosis fungoides , medicine , calcitriol , sarcoidosis , hemodialysis , vitamin d and neurology , hyperparathyroidism , parathyroid hormone , end stage renal disease , dermatology , gastroenterology , psoriasis , pathology , calcium , lymphoma
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.