Respiratory, Cork University Hospital, Cork, Ireland
Respiratory, Cork University Hospital, Cork, Ireland.
BMJ Case Rep. 2023 Jan 23;16(1):e250580. doi: 10.1136/bcr-2022-250580.
Vitamin D deficiency is relatively common, and its management in patients with sarcoidosis is challenging due to the risk of hypercalcaemia. Our patient had an autologous stem cell transplant for multiple sclerosis and was given high-dose vitamin D concurrently with immunosuppressive therapy. The patient subsequently presented with symptomatic hypercalcaemia and an acute kidney injury. A clinical and biochemical recovery was reached by withdrawing vitamin D and administering intravenous fluids. Interestingly, new evidence suggests that activated vitamin D can actually dampen the inflammatory process in sarcoidosis, and this was reflected in a reduction of our patient's serological markers of sarcoidosis activity. One large study found no significant risk of hypercalcaemia when low doses of vitamin D were used in sarcoidosis. Where indicated, and until clear guidelines are established, we suggest using low doses of vitamin D with cautious monitoring of calcium and renal function.
维生素 D 缺乏症较为常见，由于存在高钙血症风险，因此对类肉瘤病患者的维生素 D 管理颇具挑战。我们的患者因多发性硬化症接受了自体干细胞移植，并同时接受了大剂量维生素 D 和免疫抑制治疗。随后，该患者出现了症状性高钙血症和急性肾损伤。停用维生素 D 并给予静脉补液后，患者的临床和生化情况得到了恢复。有趣的是，新证据表明，活性维生素 D 实际上可以抑制类肉瘤病中的炎症过程，这反映在我们患者的类肉瘤病活动的血清标志物减少上。一项大型研究发现，在类肉瘤病中使用低剂量维生素 D 时，没有明显的高钙血症风险。在有指征的情况下，且在明确的指南建立之前，我们建议使用低剂量维生素 D，并谨慎监测钙和肾功能。
