Lee Monica, Nguyen Khoa Anh, Kaplan Robert
Internal Medicine, Irvine School of Medicine, University of California, Irvine, California, USA.
BMJ Case Rep. 2019 May 31;12(5):e226633. doi: 10.1136/bcr-2018-226633.
Hypercalcaemia is a rare but potentially life-threatening consequence of malignancies. Solid cancers, such as lymphomas, increase serum calcium primarily through parathyroid hormone-related protein or ectopic production of 1alpha-hydroxylase. We present a case of 56-year-old woman with Sjogren's syndrome and psoriasis in the setting of chronic methotrexate (MTX) use who developed worsening hypercalcaemia and symptoms suggestive of lymphoma. Pathology results diagnosed her with MTX-induced iatrogenic immunodeficiency-associated lymphoproliferative disorder (LPD). This case reminds clinicians that chronic MTX use is associated with LPDs and can ultimately lead to hypercalcaemia. The patient's MTX and other immunosuppressive medications were stopped, and her calcium corrected with fluids and calcitonin. At her 8-month follow-up postdischarge, the patient was asymptomatic with normal laboratory results and in partial clinical remission.
高钙血症是恶性肿瘤罕见但可能危及生命的后果。实体癌，如淋巴瘤，主要通过甲状旁腺激素相关蛋白或异位产生1α-羟化酶来增加血清钙水平。我们报告一例56岁患有干燥综合征和银屑病的女性患者，长期使用甲氨蝶呤（MTX），出现高钙血症加重及提示淋巴瘤的症状。病理结果诊断她为MTX诱导的医源性免疫缺陷相关淋巴增殖性疾病（LPD）。该病例提醒临床医生，长期使用MTX与LPD相关，最终可导致高钙血症。停用了患者的MTX及其他免疫抑制药物，通过补液和降钙素使她的血钙得到纠正。出院后8个月随访时，患者无症状，实验室检查结果正常，处于部分临床缓解状态。
