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

World Journal of Nephrology 2013年第2期2卷 44-48页

作者： Takamasa Iwakura Naro Ohashi Naoko Tsuji Yoshitaka Naito shinsuke isobe Masafumi Ono Tomoyuki Fujikura Takayuki Tsuji Yukitoshi Sakao Hideo Yasuda Akihiko Kato Toshiharu Fujiyama Yoshiki Tokura Yoshihide Fujigaki First Department of Medicine Hamamatsu University School of Medicine Higashi-ku Hamamatsu 431-3192 Japan Blood Purification Unit Hamamatsu University School of Medicine Higashi-ku Hamamatsu 431-3192 Japan Department of Dermatology Hamamatsu University School of Medicine Higashi-ku Hamamatsu 431-3192 Japan

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/d L, and his intact parathyroid hormone level was 121.9 pg/mL(normal range 13.9-78.5pg/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/m L), while the 1,25-dihy-droxyvitamin D3(calcitriol) level increased(114 pg/mL, normal range: 20.0-60.0 pg/m L) 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.

关键词： Calcitriol-induced hypercalcemia Granulomatous mycosis

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