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Intravascular calcium deposits in a critically ill patient. Light- and electron-microscopic findings
A C Hamoudi1, C T Singley, D H Teitelbaum
1Department of Laboratory Medicine, Children's Hospital, Columbus, Ohio.
Insights
A pediatric case revealed amorphous hematoxyphilic deposits in vascular lumina. These deposits were identified as calcium hydroxyapatite crystals, linked to hypercalcemia and total parenteral nutrition.
Area of Science:
- Pediatric Pathology
- Vascular Biology
- Mineral Metabolism
Background:
- A 2-year-old girl presented with a history of intestinal obstruction requiring prolonged total parenteral nutrition.
- The patient developed severe hypercalcemia, with calcium levels reaching 4.63 mmol/L.
Observation:
- An unusual amorphous hematoxyphilic substance was observed within the pulmonary and myocardial vascular lumina.
- Histochemical staining demonstrated a strong positive reaction for calcium and a weak positive reaction for fibrin.
Findings:
- Electron microscopy revealed a distinctive crystalline configuration consistent with calcium hydroxyapatite crystals.
- The intravascular deposits were primarily composed of calcium, with a minor fibrin component.
Implications:
- This case highlights a rare cause of vascular obstruction in pediatric patients receiving total parenteral nutrition.
- Understanding the composition of these deposits is crucial for managing hypercalcemia and preventing vascular complications.
Abstract:
We describe a case of a 2-year-old girl with an unusual finding of amorphous hematoxyphilic substance in the pulmonary and myocardial vascular lumina. The patient had a prolonged history of intestinal obstruction necessitating extended periods of total parenteral nutrition. The patient terminally had hypercalcemia with levels reaching 4.63 mmol/L. The intravascular substance stains strongly positive for calcium, and weakly positive for fibrin. Electron microscopy shows that the substance has a distinctive configuration suggestive of calcium hydroxyapatite crystals.