Case Report
 
Calcitriol mediated hypercalcemia due to necrotizing sarcoid granuloma of the liver
Priyadarshini Balasubramanian1, Deepak Kana Kadayakkara1, Gregory Soloway2, William Laskin3, Sachin Majumdar4,5
1MD, Resident, Department of Internal medicine, Bridgeport Hospital, Bridgeport, Connecticut, USA
2MD, Consultant Gastroenterologist, Department of Gastroenterology, Bridgeport Hospital, Bridgeport, Connecticut, USA
3Associate Professor of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
4Chief, Section of Endocrinology, Bridgeport Hospital, Bridgeport, Connecticut, USA
5Assistant Clinical Professor of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

Article ID: Z01201707CR10807PB
doi:10.5348/ijcri-201768-CR-10807

Address correspondence to:
Priyadarshini Balasubramanian
Bridgeport Hospital, 267 Grant Street
Bridgeport, Connecticut
USA, 06610

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How to cite this article
Balasubramanian P, Kadayakkara DK, Soloway G, Laskin W, Majumdar S. Calcitriol mediated hypercalcemia due to necrotizing sarcoid granuloma of the liver. Int J Case Rep Images 2017;8(7):458–461.

ABSTRACT

Introduction: Necrotizing sarcoid granulomatosis (NSG) is a rare variant of sarcoidosis with pathologic features of necrosis and vasculitis that overlap with rheumatologic and infectious diseases. Hypercalcemia is occasionally the presenting feature of classical sarcoidosis occurring in 10–20% of patients, most commonly in association with pulmonary involvement. However hypercalcemia in NSG is less common and has not been previously described when NSG primarily affects the liver.
Case Report: We report a 65-year-old Caucasian female who presented with hypercalcemia and NSG of the liver without pulmonary involvement.
Conclusion: Hypercalcemia was mediated by 1, 25-vitamin D which was most likely produced by hepatic granulomas and it resolved rapidly with prednisone. Further, we describe the time-course for the resolution of hypercalcemia and other biochemical abnormalities with treatment, and suggest potential roles for monitoring 1, 25-dihydroxyvitamin D and angiotensin converting enzyme in guiding therapy.

Keywords: 1,25-Dihydroxyvitamin D, Hepatic granuloma, Hypercalcemia, Necrotizing sarcoid granuloma



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Author Contributions
Priyadarshini Balasubramanian – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Deepak Kana Kadayakkara – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Gregory Soloway – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
William Laskin – Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Sachin Majumdar – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Priyadarshini Balasubramanian et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.