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Refractory hypercalcemia in an infant secondary to talc pleurodesis resolving after renal transplantation

S J Aujla1, P Michelson, C B Langman

  • 1Division of Pulmonary Medicine, Allergy and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|May 1, 2008
PubMed

Insights

Talc pleurodesis can cause severe hypercalcemia due to extrarenal 1,25-dihydroxyvitamin D production. Alemtuzumab treatment following renal transplantation resolved this complication in an infant.

Area of Science:

  • Nephrology
  • Endocrinology
  • Immunology

Background:

  • Talc pleurodesis is standard for recurrent pneumothorax, typically without metabolic issues.
  • Recurrent peritoneal dialysis-related hydrothorax necessitates interventions like talc pleurodesis.

Observation:

  • An anephric infant developed severe hypercalcemia six months post-talc pleurodesis.
  • Elevated 1,25-dihydroxyvitamin D (1,25[OH]2D) levels, from macrophage-derived extrarenal production in a talc granuloma, caused the hypercalcemia.

Findings:

  • Hypercalcemia was managed with diet, dialysis, ketoconazole, and hydroxychloroquine, but 1,25[OH]2D remained high.
  • Renal transplantation with alemtuzumab pre-conditioning resolved hypercalcemia and normalized 1,25[OH]2D levels.

Implications:

  • Talc pleurodesis can lead to hypercalcemia via extrarenal 1,25(OH)2D production.
  • Alemtuzumab, targeting macrophages, may treat hypercalcemia in granulomatous conditions.

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