Department of Diabetes & Endocrinology, Stirling Royal Infirmary, Forth Valley Acute Hospitals, Stirling FK8 2AU, UK.
Scott Med J. 2011 Aug;56(3):181. doi: 10.1258/smj.2011.011121.
A 67-year-old trout fisherman presented with a six-week history of polyuria, polydipsia, dyspnoea on exertion and the development of subcutaneous extensor surface skin nodules. He was hypercalcaemic with acute renal impairment. Parathyroid hormone was suppressed and vitamin D levels were within normal limits. The patient had a past history of hypothyroidism, but thyroid replacement was adequate. Hypoadrenalism, myeloma and metastatic malignancy were excluded. Biopsy of a subcutaneous nodule revealed dermally based non-caseating granulomata, consistent with sarcoidosis. Serum angiotensin-converting enzyme was elevated, and computerized tomography scanning of the chest and abdomen revealed widespread lymphadenopathy with multiple lung nodules and splenomegaly. Prednisolone therapy produced rapid resolution of his skin lesions and normalization of his bone and renal biochemistry. The mechanism of hypercalcaemia in sarcoidosis is poorly understood but is thought to involve parathyroid hormone-independent 1-hydroxylation of 25-hydroxyvitamin D within sarcoid lesions. This process may be exacerbated by exposure to UV light and it is of interest that this patient developed symptoms after a period of intense trout fishing in the good weather of April and May 2007.
一位 67 岁的鳟鱼渔民出现多尿、多饮、活动时呼吸困难以及伸肌表面皮肤结节的症状，病史已有 6 周。患者血钙升高且伴有急性肾功能损害。甲状旁腺激素受抑制，维生素 D 水平正常。患者有甲状腺功能减退症病史，但甲状腺激素替代治疗充分。已排除肾上腺功能减退症、骨髓瘤和转移性恶性肿瘤。皮肤结节活检显示真皮非干酪性肉芽肿，符合结节病。血清血管紧张素转换酶升高，胸部和腹部计算机断层扫描显示广泛的淋巴结病，伴有多个肺结节和脾肿大。泼尼松龙治疗使他的皮肤病变迅速消退，骨骼和肾脏生物化学指标恢复正常。结节病中高钙血症的机制尚不清楚，但据认为与结节病病变中甲状旁腺激素非依赖性 25-羟维生素 D 的 1-羟化有关。这个过程可能会因暴露于紫外线下而加重，有趣的是，该患者在 2007 年 4 月和 5 月天气良好时，进行了一段时间的高强度鳟鱼捕捞后出现了这些症状。
