title: Hypercalcemia associated with mineral oil-induced sclerosing paraffinomas.
abstract: OBJECTIVE
  Granuloma-forming diseases such as sarcoidosis are associated with extrarenal synthesis of 1,25-dihydroxyvitamin D [1,25(OH)₂D]. We describe a case of extensive skin lesions associated with mineral oil injections in which we provide evidence for cutaneous granuloma synthesis of 1,25(OH)₂D in the pathogenesis of the patient's hypercalcemia.
  
  
  METHODS
  Analysis of expression of the 25(OH)D-1a-hydroxylase (1-a OHase [CYP27b1]) was carried out by immunohistochemical analysis of involved skin.
  
  
  RESULTS
  In involved skin, expression of CYP27b1 was found in the dermis, where it is not normally expressed. Successful management of hypercalcemia was achieved with glucocorticoids.
  
  
  CONCLUSIONS
  Hypercalcemia associated with mineral oil induced skin lesions is likely driven by unregulated expression of CYP27b1 by inflammatory monocytes and macrophages infiltrating the dermis.
authors: Eunice Shriver Kennedy National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, Maryland, USA. moraitia@mail.nih.gov
authors: Andreas G
authors: AG
authors: Moraitis
authors: Martin
authors: M
authors: Hewison
authors: Michael
authors: M
authors: Collins
authors: Candido
authors: C
authors: Anaya
authors: Michael F
authors: MF
authors: Holick
mesh_terms: D015090:25-Hydroxyvitamin D3 1-alpha-Hydroxylase / Q000378:metabolism; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D002481:Cellulitis / Q000139:chemically induced / Q000601:surgery; D003357:Cosmetic Techniques / Q000009:adverse effects; D005938:Glucocorticoids / Q000627:therapeutic use; D006099:Granuloma / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology* / Q000517:prevention & control; D007279:Injections, Subcutaneous; D035002:Lower Extremity; D008264:Macrophages / Q000187:drug effects / Q000201:enzymology / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D008899:Mineral Oil / Q000008:administration & dosage / Q000009:adverse effects; D009000:Monocytes / Q000187:drug effects / Q000201:enzymology / Q000276:immunology*; D011183:Postoperative Complications / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D011241:Prednisone / Q000627:therapeutic use; D012598:Sclerosis; D012867:Skin / Q000187:drug effects / Q000201:enzymology / Q000276:immunology* / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000503:physiopathology*; D016038:Skin Transplantation / Q000009:adverse effects / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D005938:Glucocorticoids; D008899:Mineral Oil; D015090:25-Hydroxyvitamin D3 1-alpha-Hydroxylase; D011241:Prednisone