Jorge Ahmed, Szulawski Robert, Abhishek Fnu
Department of Medicine, UPMC Mercy, Pittsburgh, Pennsylvania, USA.
BMJ Case Rep. 2019 Feb 25;12(2):e223992. doi: 10.1136/bcr-2017-223992.
Metastatic calcinosis cutis results from abnormal calcium levels leading to the precipitation of insoluble calcium salts in the skin and subcutaneous tissue. Here, we present the case of a 67-year-old man with multiple sclerosis on chronic dexamethasone and concurrent supplementation of calcium and daily cholecalciferol presenting with painful calcified lesions. During initial presentation, corrected calcium was 13.8 mg/dL (reference range: 8.5-10.1 mg/dL), ionised calcium was 1.70 mg/dL (reference range: 1.13-1.32 mg/dL) and 25-hydroxyvitamin D was 41.6 ng/mL (reference range 30-100 ng/mL). Normocalcaemia was restored with the off-label use of denosumab, usually reserved for hypercalcaemia of malignancy and intractable osteoporosis. We discuss potential aetiologies of this patient's hypercalcaemia, calcinosis cutis diagnosis and management and the off-label use of denosumab.
转移性皮肤钙化症是由钙水平异常导致不溶性钙盐在皮肤和皮下组织中沉淀引起的。在此，我们报告一例67岁男性，患有多发性硬化症，长期使用地塞米松，并同时补充钙和每日胆钙化醇，出现疼痛性钙化病变。初次就诊时，校正钙为13.8mg/dL（参考范围：8.5 - 10.1mg/dL），离子钙为1.70mg/dL（参考范围：1.13 - 1.32mg/dL），25 - 羟基维生素D为41.6ng/mL（参考范围30 - 100ng/mL）。通过使用地诺单抗（通常用于治疗恶性肿瘤高钙血症和难治性骨质疏松症）的超说明书用法，恢复了正常血钙水平。我们讨论了该患者高钙血症的潜在病因、皮肤钙化症的诊断和管理以及地诺单抗的超说明书用法。
