title: Calcitriol-induced hypercalcemia in a patient with granulomatous mycosis fungoides and end-stage renal disease.
abstract: An 86-year-old man, diagnosed as having mycosis fungoides in May 2008 and treated with repeated radiation therapy, was admitted to our hospital for initiation of hemodialysis due to end-stage renal disease (ESRD) in April 2012. On admission, his corrected serum calcium level was 9.3 mg/dL, and his intact parathyroid hormone level was 121.9 pg/mL (normal range 13.9-78.5 pg/mL), indicating secondary hyperparathyroidism due to ESRD. After starting hemodialysis, urinary volume diminished rapidly. The serum calcium level increased (12.7 mg/dL), and the intact parathyroid hormone level was suppressed (< 5 pg/mL), while the 1,25-dihydroxyvitamin D3 (calcitriol) level increased (114 pg/mL, normal range: 20.0-60.0 pg/mL) in June 2012. The possibilities of sarcoidosis and tuberculosis were ruled out. Skin biopsies from tumorous lesions revealed a diagnosis of granulomatous mycosis fungoides. The serum soluble interleukin-2 receptor levels and the degrees of skin lesions went in parallel with the increased serum calcium and calcitriol levels. Therefore, the patient was diagnosed as having calcitriol-induced hypercalcemia possibly associated with granulomatous mycosis fungoides. Granulomatous mycosis fungoides is rare, and its association with calcitriol-induced hypercalcemia has not been reported. Careful attention to calcium metabolism is needed in patients with granulomatous mycosis fungoides, especially in patients with ESRD.
authors.affiliation: Takamasa Iwakura, Naro Ohashi, Naoko Tsuji, Yoshitaka Naito, Shinsuke Isobe, Masafumi Ono, Tomoyuki Fujikura, Takayuki Tsuji, Hideo Yasuda, Yoshihide Fujigaki, First Department of Medicine, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu 431-3192, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Iwakura
authors.forename: Naro
authors.initials: N
authors.lastname: Ohashi
authors.forename: Naoko
authors.initials: N
authors.lastname: Tsuji
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Naito
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Isobe
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ono
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujikura
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tsuji
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Sakao
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasuda
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kato
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Fujiyama
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Tokura
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Fujigaki
keywords: Calcitriol-induced hypercalcemia; Granulomatous mycosis