Calcitriol-induced hypercalcemia in a patient with granulomatous mycosis fungoides and end-stage renal disease

• Published in: World journal of nephrology 2013-05, Vol.2 (2), p.44-48
• Main Authors: Iwakura, Takamasa, Ohashi, Naro, Tsuji, Naoko, Naito, Yoshitaka, Isobe, Shinsuke, Ono, Masafumi, Fujikura, Tomoyuki, Tsuji, Takayuki, Sakao, Yukitoshi, Yasuda, Hideo, Kato, Akihiko, Fujiyama, Toshiharu, Tokura, Yoshiki, Fujigaki, Yoshihide
• Format: Article
• Language: English
• Subjects: Case Report
• ISSN: 2220-6124; 2220-6124
• DOI: 10.5527/wjn.v2.i2.44

An 86-year-old man, diagnosed as having mycosis fungoides in May 2008 and treated with repeated radiation therapy, was admitted to our hospital for initiation of hemodialysis due to end-stage renal disease(ESRD) in April 2012. On admission, his corrected serum calcium level was 9.3 mg/d L, and his intact parathyroid hormone level was 121.9 pg/mL(normal range 13.9-78.5pg/mL), indicating secondary hyperparathyroidism due to ESRD. After starting hemodialysis, urinary volume diminished rapidly. The serum calcium level increased(12.7 mg/dL), and the intact parathyroid hormone level was suppressed(< 5 pg/m L), while the 1,25-dihy-droxyvitamin D3(calcitriol) level increased(114 pg/mL, normal range: 20.0-60.0 pg/m L) in June 2012. The possibilities of sarcoidosis and tuberculosis were ruled out. Skin biopsies from tumorous lesions revealed a diagnosis of granulomatous mycosis fungoides. The serum soluble interleukin-2 receptor levels and the degrees of skin lesions went in parallel with the increased serum calcium and calcitriol levels. Therefore, the patient was diagnosed as having calcitriol-induced hypercalcemia possibly associated with granulomatous mycosis fungoides. Granulomatous mycosis fungoides is rare, and its association with calcitriol-induced hypercalcemia has not been reported. Careful attention to calcium metabolism is needed in patients with granulomatous mycosis fungoides, especially in patients with ESRD.