Hypercalcemia due to giant cell myocarditis: a case report.
Ami M Patel1, Mariell Jessup, John Tomaszewski
1Drexel University College of Medicine, Philadelphia, Pennsylvania.
Progress in Transplantation (Aliso Viejo, Calif.)
|December 7, 2013
Summary
Giant cell myocarditis, a rare granulomatous disease, can cause hypercalcemia through excess vitamin D production. Steroid therapy and heart transplant resolved the condition in this unique case.
Area of Science:
- Endocrinology
- Cardiology
- Nephrology
Background:
- Granulomatous diseases are an uncommon cause of hypercalcemia.
- Pathogenesis involves endogenous 1,25-dihydroxyvitamin D production by activated macrophages in granulomatous lesions.
Observation:
- The first reported case of hypercalcemia associated with giant cell myocarditis is presented.
- A patient with giant cell myocarditis developed progressive heart failure, cardiorenal syndrome, and subsequently hypercalcemia with elevated 1,25-vitamin D and suppressed PTH levels during stage 4 chronic kidney disease.
Findings:
- Hypercalcemia in this patient was attributed to extrarenal calcitriol production linked to giant cell myocarditis.
- Other potential causes of hypercalcemia, including vitamin D intoxication and multiple myeloma, were ruled out.
- Treatment with low-dose steroids normalized calcium levels, which remained stable after heart transplantation.
Implications:
- This case highlights giant cell myocarditis as an unusual cause of hypercalcemia.
- It underscores the importance of considering extrarenal 1,25-dihydroxyvitamin D production in granulomatous diseases.
- The findings suggest a potential therapeutic role for steroids in managing such cases.
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