Fatima Paras, Czerwinski Vincent, Panthi Sujata, Choudhary Chitra
Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
University of Kansas School of Medicine, Kansas City, Kansas.
AACE Clin Case Rep. 2023 Dec 13;10(2):45-48. doi: 10.1016/j.aace.2023.12.002. eCollection 2024 Mar-Apr.
BACKGROUND/OBJECTIVE: Hypercalcemia is a common disorder with a wide differential and is most commonly related to malignancy and hyperparathyroidism. Hypercalcemia is a rarely reported consequence of graft-versus-host disease (GVHD) and may be related to a granulomatous manifestation of the common stem cell transplantation procedure.
A 67-year-old woman with a history of allogenic stem cell transplantation due to myelodysplastic syndrome presented to the bone marrow transplant clinic with dysphagia, muscle aches, and rash. She was found to have an extremely increased calcium and 1,25-dihydroxyvitamin D levels, which were ultimately corrected with administration of steroids and zoledronic acid.
While uncommon, granulomatous disease can lead to hypercalcemia via the activation of 1α-hydroxylase within macrophages, which, in turn, activates 1,25-dihydroxyvitamin D leading to an increased serum calcium level. GVHD is a common, variably presenting complication of bone marrow transplantation. Granulomatous processes related to GVHD may mediate hypercalcemia in patients with both increased calcium and 1,25-dihydroxyvitamin D levels.
This is a rare cause of calcitriol-mediated hypercalcemia associated with GVHD. There have been cases of granulomas associated with GVHD, and this could potentially lead to ectopic production of calcitriol. We deemed GVHD to be a likely cause of the patient's calcitriol-mediated hypercalcemia because we did not find another etiology that fit the clinical findings. Physician awareness of this complication and the appropriate workup will allow future researchers to properly elucidate the etiology of this rare complication.
背景/目的：高钙血症是一种常见疾病，鉴别诊断范围广泛，最常与恶性肿瘤和甲状旁腺功能亢进有关。高钙血症是移植物抗宿主病（GVHD）极少报道的后果，可能与常见干细胞移植程序的肉芽肿表现有关。
一名67岁女性，有因骨髓增生异常综合征进行异基因干细胞移植的病史，因吞咽困难、肌肉疼痛和皮疹就诊于骨髓移植诊所。发现她的钙和1,25 - 二羟维生素D水平极度升高，最终通过给予类固醇和唑来膦酸得以纠正。
虽然罕见，但肉芽肿性疾病可通过巨噬细胞内1α - 羟化酶的激活导致高钙血症，这反过来又激活1,25 - 二羟维生素D，导致血清钙水平升高。GVHD是骨髓移植常见的、表现多样的并发症。与GVHD相关的肉芽肿过程可能在钙和1,25 - 二羟维生素D水平均升高的患者中介导高钙血症。
这是与GVHD相关的维生素D介导的高钙血症的罕见原因。已有与GVHD相关的肉芽肿病例，这可能潜在地导致维生素D的异位产生。我们认为GVHD是患者维生素D介导的高钙血症的可能原因，因为我们未发现符合临床发现的其他病因。医生对这种并发症的认识以及适当的检查将使未来的研究人员能够正确阐明这种罕见并发症的病因。
