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Particle disease: a unique cause of hypercalcemia
1Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Summary
Particle disease from failed joint implants can cause hypercalcemia. This occurs due to unregulated 1,25-dihydroxyvitamin D production by macrophages, leading to elevated calcium levels.
Area of Science:
- Endocrinology
- Orthopedics
- Pathology
Background:
- Ectopic 1,25-dihydroxyvitamin D production by activated macrophages causes hypercalcemia in granulomatous diseases.
- Particle disease, an inflammatory response to failed joint prosthesis debris, involves focal bone resorption but has not been linked to hypercalcemia.
Observation:
- A patient presented with hypercalcemia, low parathyroid hormone, and elevated 1,25-dihydroxyvitamin D.
- The patient had a failed prosthetic hip generating significant inflammatory debris, forming a soft tissue mass with lymphadenopathy.
Findings:
- Biopsy revealed activated macrophages and foreign body granuloma within the soft tissue mass.
- This granulomatous inflammation led to unregulated 1,25-dihydroxyvitamin D production and subsequent hypercalcemia.
Implications:
- This is the first reported case of hypercalcemia with elevated 1,25-dihydroxyvitamin D in particle disease.
- Highlights a novel mechanism for hypercalcemia in patients with failed orthopedic implants.
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