Active crohn disease and hypercalcemia treated with infliximab: case report and literature review.
OBJECTIVE
To report a case of 1,25-dihydroxyvitamin D-mediated hypercalcemia caused by active Crohn disease that improved with infliximab therapy.


METHODS
We present the clinical and laboratory findings and describe the clinical course of a patient who had hypercalcemia during Crohn disease exacerbations. The literature is reviewed regarding 1,25-dihydroxyvitamin D production in Crohn disease, and the 3 cases of hypercalcemia in individuals with Crohn disease reported in the literature are described.


RESULTS
A 50-year-old man with long-standing Crohn disease treated with multiple bowel resections presented for take-down ileostomy. He was hypercalcemic and had suppressed parathyroid hormone and parathyroid hormone-related peptide levels. Histopathology of the resected ileostomy site and adjacent small bowel indicated active Crohn disease. Hypercalcemia promptly resolved after a few days of treatment with intravenous glucocorticoids. One month later, hypercalcemia recurred in the presence of an inappropriately high 1,25-dihydroxyvitamin D level and increased urinary calcium and serum angiotensin-converting enzyme levels. The serum and urinary calcium levels became normal with infliximab therapy. Three previous reports of hypercalcemia caused by active Crohn disease describe effective treatment with glucocorticoids. This is the first report of successful response to infliximab in this setting.


CONCLUSIONS
Hypercalcemia mediated by 1,25-dihydroxyvitamin D in the setting of Crohn disease may respond to glucocorticoid-sparing immunomodulators.
Ioachimescu
Adriana G
AG
Department of Endocrinology, Diabetes, and Metabolism, Cleveland Clinic, A53, 9500 Euclid Avenue, Cleveland, OH 44195, USA. licataa@ccf.org
Bauer
Thomas W
TW
Licata
Angelo
A
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy* / Q000209:etiology*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D014807:Vitamin D / Q000009:adverse effects / Q000097:blood
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D010281:Parathyroid Hormone; D014807:Vitamin D; D000069285:Infliximab; D002117:Calcitriol; D002118:Calcium