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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
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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
PubMed

Insights

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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