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Systemic lupus erythematosus presenting as acute symptomatic hypercalcemia
J G Erdozain1, M V Egurbide, G Ruiz-Irastorza
1Service of Internal Medicine, Hospital de Cruces, Universidad del Pais Vasco/Euskal Herriko Unibertsitatea, Bizkaia, Spain.
Lupus
|March 5, 2004
Summary
Systemic lupus erythematosus (SLE) is an uncommon cause of hypercalcemia, often presenting with severe symptoms. This case highlights SLE as a potential diagnosis for unexplained hypercalcemia, even as an initial manifestation.
Area of Science:
- Internal Medicine
- Rheumatology
- Endocrinology
Background:
- Hypercalcemia is a frequent electrolyte disturbance with established common causes like primary hyperparathyroidism and malignancy.
- These two conditions account for over 90% of hypercalcemia cases, necessitating a broad differential diagnosis.
Observation:
- A woman presented with symptomatic severe hypercalcemia.
- Diagnostic workup revealed clinical and serological markers of systemic lupus erythematosus (SLE), including arthritis, lymphopenia, antinuclear antibodies (ANA), anti-DNA, anti-Ro antibodies, and low C3 complement levels.
Findings:
- The patient's hypercalcemia resolved with standard acute treatment (IV fluids, steroids, diuretics, pamidronate) and remained normalized on low-dose prednisone.
- This case, along with five previously reported instances, establishes SLE as a rare but significant cause of hypercalcemia.
Implications:
- Systemic lupus erythematosus should be considered in the differential diagnosis of hypercalcemia, particularly in patients with suggestive clinical or serological findings.
- Hypercalcemia can be an initial presenting feature of SLE, underscoring the importance of comprehensive evaluation in unexplained cases.