Reactions 1202 - 17 May 2008

Ergocalciferol

Hypercalcaemia in an elderly patient withsarcoidosis: case report

A 66-year-old man with undiagnosed sarcoidosis developedhypercalcaemia while receiving an ergocalciferol supplement[therapeutic indication not stated].

The man, who had stage 4 chronic kidney disease, startedreceiving ergocalciferol [vitamin D2] 50 000 IU/month andpresented with lethargy and constipation a few weeks later.His history included renal cell cancer, nephrectomy andgranulomatous uveitis; he had a red inflamed eye onpresentation. Laboratory investigations revealed the followingserum levels: calcium 17 mg/dL, blood urea nitrogen30 mg/dL, creatinine 3.6 mg/dL, intact parathyroid hormone(iPTH) 2.5 pg/mL, 25-vitamin D 19 ng/mL and 1,25 vitamin D124 pg/dL.

The man received IV hydration therapy and calcitoninwithout improvement of his hypercalcaemia. His angiotensinconverting enzyme level was 119 U/L. Multiple pulmonarynodules were revealed on chest CT scan, and transbronchialbiopsy findings were compatible with sarcoidosis. Prednisonewas then initiated, and his hypercalcaemia resolved.

Author comment: "[W]e suspect that supplementalergocalciferol was metabolized to 25-vitamin D which wasrapidly converted to large amounts of 1,25-vitamin D bysarcoid macrophages leading to severe hypercalcemia."Nigwekar SU, et al. Sarcoidosis unmasked. American Journal of Kidney Diseases51: A74 abstr. 185, No. 4, Apr 2008 - USA 801110185

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Reactions 17 May 2008 No. 12020114-9954/10/1202-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved