甲氨蝶呤治疗结节病引起的高钙血症。
METHOTREXATE TREATMENT FOR SARCOIDOSIS-INDUCED HYPERCALCEMIA.
作者信息
Baraf Lior, Abu-Shakra Mahmoud
出版信息
AACE Clin Case Rep. 2020 Aug 6;6(6):e311-e314. doi: 10.4158/ACCR-2020-0120. eCollection 2020 Nov-Dec.
OBJECTIVE
To present a patient with sarcoidosis-induced hypercalcemia who responded to methotrexate (MTX).
METHODS
The described case includes clinical and biochemical reports.
RESULTS
A 65-year-old woman presented with bilateral hilar lymphadenopathy and pulmonary nodules. Her calcium and phosphorous levels were 11.4 mg/dL and 3.5 mg/dL, respectively. Blood levels of 25-hydroxyvitamin D and parathyroid hormone were 68 nmol/L and 23 pg/dL, respectively. A diagnosis of sarcoidosis was confirmed by a lymph node biopsy that revealed non-caseating granulomas. Prednisone therapy was efficacious in normalizing the calcium level. However, hypercalcemia recurred when the prednisone dosage was tapered to below15 mg daily. Following initiation of MTX at 15 mg/week, prednisone levels were successfully titrated to 3 mg daily. After a temporary withdrawal of MTX therapy, calcium levels increased dramatically to 17 mg/dL.
CONCLUSION
MTX can be used as treatment for sarcoidosis-induced hypercalcemia.
目的
报告一例对甲氨蝶呤（MTX）有反应的结节病诱发的高钙血症患者。
方法
所描述的病例包括临床和生化报告。
结果
一名65岁女性出现双侧肺门淋巴结肿大和肺部结节。她的钙和磷水平分别为11.4毫克/分升和3.5毫克/分升。25-羟维生素D和甲状旁腺激素的血液水平分别为68纳摩尔/升和23皮克/分升。淋巴结活检显示非干酪样肉芽肿，从而确诊为结节病。泼尼松治疗可有效使钙水平恢复正常。然而，当泼尼松剂量减至每日低于15毫克时，高钙血症复发。在开始每周15毫克的MTX治疗后，泼尼松水平成功滴定至每日3毫克。在MTX治疗暂时停药后，钙水平急剧升至17毫克/分升。
结论
MTX可用于治疗结节病诱发的高钙血症。
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