Rapid skeletal turnover and hypercalcemia associated with markedly elevated interleukin-6 levels in a young black man.
A 24-year-old black man presented with diffuse musculoskeletal pain and shotty lymphadenopathy. Laboratory studies revealed hypercalcemia and hyperphosphatemia, very high serum alkaline phosphatase activity, diffuse but intense uptake of radionuclide on a bone scan, urinary N-telopeptide excretion 30 times the upper limit of normal, and serum interleukin-6 100 times the upper limit of normal. An extensive workup for etiologies of the disorder was negative. A bone biopsy revealed intense osteoclastic resorption coupled with rapid bone formation and/or remodeling. This case appears to represent a new entity. Treatment with bisphosphonates produced symptomatic and biochemical improvement.
Greenwald
R A
RA
Division of Rheumatology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA. rgreen@lij.edu
Stein
B
B
Miller
F
F
D000328:Adult; D019386:Alendronate / Q000627:therapeutic use; D000469:Alkaline Phosphatase / Q000097:blood; D044383:Black People; D016723:Bone Remodeling; D001842:Bone and Bones / Q000000981:diagnostic imaging; D003094:Collagen / Q000652:urine; D024042:Collagen Type I; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D010010:Osteoclasts / Q000473:pathology; D010014:Osteolysis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000077268:Pamidronate; D010455:Peptides / Q000652:urine; D010710:Phosphates / Q000097:blood; D011877:Radionuclide Imaging
D024042:Collagen Type I; D004164:Diphosphonates; D015850:Interleukin-6; D010455:Peptides; D010710:Phosphates; C052929:collagen type I trimeric cross-linked peptide; D003094:Collagen; D000469:Alkaline Phosphatase; D000077268:Pamidronate; D019386:Alendronate