Calcitriol-mediated hypercalcaemia and increased interleukins in a patient with sarcoid myopathy.
In this report we describe a patient with Sjögren's syndrome (SS) and calcitriol-mediated hypercalcaemia. Initially, there was no clinical evidence of sarcoidosis. The patient had hypercalcaemia associated with increased calcitriol serum levels; circulating interleukin-6 and tumour necrosis factor alpha levels were also elevated. At the beginning, therapy with clodronate was effective in decreasing the serum calcium levels. However, the serum calcitriol decreased only after chloroquine treatment was added. After 2 years of therapy, the patient developed progressive and extensive muscle weakness. A muscle biopsy revealed a very prominent non-caseating granulomatous myopathy. Corticosteroid therapy was then instituted. Although both chloroquine and corticosteroid therapy were associated with decreased serum interleukin and calcitriol levels, only corticosteroid therapy was effective in treating the sarcoid myopathy. The role of cytokines in calcitriol mediated hypercalcaemia is discussed.
Peris
P
P
Service of Rheumatology, Hospital Clinic, University of Barcelona, Spain.
Font
J
J
Grau
J M
JM
Martínez de Osaba
M J
MJ
Filella
X
X
Muñoz-Gómez
J
J
D018501:Antirheumatic Agents / Q000627:therapeutic use; D002116:Calcitonin / Q000627:therapeutic use; D002117:Calcitriol / Q000097:blood*; D002738:Chloroquine / Q000627:therapeutic use; D004002:Clodronic Acid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D015850:Interleukin-6 / Q000097:blood; D007378:Interleukins / Q000097:blood*; D008875:Middle Aged; D018908:Muscle Weakness / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D012859:Sjogren's Syndrome / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D018501:Antirheumatic Agents; D015850:Interleukin-6; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha; D004002:Clodronic Acid; D002738:Chloroquine; D002116:Calcitonin; D011239:Prednisolone; D002117:Calcitriol