title: Systemic lupus erythematosus-related hypercalcemia with ectopic calcinosis.
abstract: We report a case of a 39-year-old female with active systemic lupus erythematosus who complained of lethargy and weakness with a moderate renal impairment. Hypercalcemia was confirmed by laboratory examination. Her X-ray revealed significant ectopic calcinosis in subcutaneous tissue of bilateral hands, and Tc-99(m) methylene diphosphonate bone scan revealed a remarkably intense uptake of bilateral lungs. She had no evidence suggestive of other diseases related to hypercalcemia such as hyperparathyroidism and malignancy. She had abnormally high serum parathyroid hormone-related protein (PTHrP) which fell to normal after treatment. Glucocorticoid, cyclophosphamide plus calcitonin and etidronate were administered and the patient improved greatly. Literature review demonstrated that lupus-related hypercalcemia with ectopic calcinosis is a rare complication and increased PTHrP is probably one of the main mechanisms. Lung uptake in bone scan may be a special and reliable clue suggestive of hypercalcemia.
authors.affiliation: Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan 1#, Dongcheng District, Beijing, 100730, China.
authors.forename: Lidan
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan 1#, Dongcheng District, Beijing, 100730, China.
authors.forename: Linfang
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan 1#, Dongcheng District, Beijing, 100730, China. zxpumch2003@sina.com.
authors.forename: Xuan
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002114:Calcinosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D002116:Calcitonin / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D012968:Etidronic Acid / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008168:Lung / Q000000981:diagnostic imaging; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D010281:Parathyroid Hormone / Q000097:blood; D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate; D016896:Treatment Outcome; D051598:Whole Body Imaging
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; C470125:PTH protein, human; D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D003520:Cyclophosphamide; D002116:Calcitonin; D012968:Etidronic Acid; D013669:Technetium Tc 99m Medronate
keywords: Calcinosis; Hypercalcemia; Parathyroid hormone-related protein; Systemic lupus erythematosus