Tiwari Vaibhav, Arora Veronica, Rajput Jitendra, Gupta Anurag, Divyaveer Smita, Bijarnia-Mahay Sunita, Gupta Pallav, Bhargava Vinant, Malik Manish, Gupta Ashwani, Bhalla Anil Kumar, Rana D S
Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India.
Department of Institute of Medical Genetics, Sir Ganga Ram Hospital, New Delhi, India.
Indian J Nephrol. 2022 Jan-Feb;32(1):71-75. doi: 10.4103/ijn.IJN_389_20. Epub 2021 Dec 30.
A 33-year-old man came with nausea, vomiting and abdominal pain due to hypercalcaemia and renal dysfunction following two doses of intramuscular vitamin D injections. Levels of vitamin D were repeatedly above 300 ng/ml over a period of 10 months. Whole-body PET CT scan revealed a thin-walled collection in the right gluteal region. The patient refused a surgical intervention for the same. After 7 months of follow-up, the abscess ruptured spontaneously and was then surgically debrided. At this point, a history of pentazocine addiction was uncovered. One month later, vitamin D levels began to fall along with improvement in serum calcium and creatinine. This case unravels a diagnostic odyssey which ended with a simple surgical debridement. We aim to highlight that vitamin D supplementation in 'megadoses' in the presence of active infection can have an exaggerated response and may take months to resolve.
一名33岁男性因两次肌肉注射维生素D后出现高钙血症和肾功能不全，伴有恶心、呕吐和腹痛前来就诊。在10个月的时间里，维生素D水平反复高于300 ng/ml。全身PET CT扫描显示右臀区域有一个薄壁积液。患者拒绝了对此进行手术干预。经过7个月的随访，脓肿自发破裂，随后进行了手术清创。此时，发现患者有喷他佐辛成瘾史。1个月后，维生素D水平开始下降，同时血清钙和肌酐有所改善。该病例揭示了一段诊断历程，最终以简单的手术清创告终。我们旨在强调，在存在活动性感染的情况下“大剂量”补充维生素D可能会产生过度反应，且可能需要数月才能恢复。
