Hypercalcemia after transplant nephrectomy in a hemodialysis patient: a case report
Identifieur interne : 000080 ( Pmc/Curation ); précédent : 000079; suivant : 000081Hypercalcemia after transplant nephrectomy in a hemodialysis patient: a case report
Auteurs : Ivo Quack [Allemagne] ; Magdalena Woznowski [Allemagne] ; Gisela Schieren [Allemagne] ; Stefan M. Weiner [Allemagne] ; Guido Winnekendonk [Allemagne] ; Faruk Tokmak [Allemagne] ; Lars C. Rump [Allemagne] ; Dirk Rattensperger [Allemagne]Source :
- Journal of Medical Case Reports [ 1752-1947 ] ; 2007.
Abstract
Hypercalcemia is a complication often seen in chronic hemodialysis patients. A rare cause of this condition is sarcoidosis. Its highly variable clinical presentation is challenging. Especially in patients suffering chronic kidney graft failure the nonspecific constitutional symptoms of sarcoidosis like fever, weight loss, arthralgia and fatigue may be easily misleading.
A 51 year old male developed hypercalcemia, arthralgia and B-symptoms after explantation of his kidney graft because of suspected acute rejection. The removed kidney showed vasculopathy and tubulointerstitial nephritis, which had not been overt in the biopsy taken half a year earlier. Despite explantation and withdrawal of the immunosuppression the patient's general condition deteriorated progressively. A rapid rise in serum calcium finally provoked us to check for sarcoidosis. CT scans of the lungs, broncho-alveolar-lavage and further lab tests confirmed the diagnosis.
This case demonstrates that withdrawal of immunosuppressive drugs sometimes unmasks sarcoidosis. It should be considered as differential diagnosis even in hemodialysis patients, in whom other reasons for hypercalcemia are much more common.
Url:
DOI: 10.1186/1752-1947-1-164
PubMed: 18053167
PubMed Central: 2241629
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<front><div type="abstract" xml:lang="en"><sec><title>Introduction</title>
<p>Hypercalcemia is a complication often seen in chronic hemodialysis patients. A rare cause of this condition is sarcoidosis. Its highly variable clinical presentation is challenging. Especially in patients suffering chronic kidney graft failure the nonspecific constitutional symptoms of sarcoidosis like fever, weight loss, arthralgia and fatigue may be easily misleading.</p>
</sec>
<sec><title>Case presentation</title>
<p>A 51 year old male developed hypercalcemia, arthralgia and B-symptoms after explantation of his kidney graft because of suspected acute rejection. The removed kidney showed vasculopathy and tubulointerstitial nephritis, which had not been overt in the biopsy taken half a year earlier. Despite explantation and withdrawal of the immunosuppression the patient's general condition deteriorated progressively. A rapid rise in serum calcium finally provoked us to check for sarcoidosis. CT scans of the lungs, broncho-alveolar-lavage and further lab tests confirmed the diagnosis.</p>
</sec>
<sec><title>Conclusion</title>
<p>This case demonstrates that withdrawal of immunosuppressive drugs sometimes unmasks sarcoidosis. It should be considered as differential diagnosis even in hemodialysis patients, in whom other reasons for hypercalcemia are much more common.</p>
</sec>
</div>
</front>
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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Med Case Reports</journal-id>
<journal-title>Journal of Medical Case Reports</journal-title>
<issn pub-type="epub">1752-1947</issn>
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<article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group><article-title>Hypercalcemia after transplant nephrectomy in a hemodialysis patient: a case report</article-title>
</title-group>
<contrib-group><contrib id="A1" contrib-type="author"><name><surname>Quack</surname>
<given-names>Ivo</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<xref ref-type="aff" rid="I4">4</xref>
<email>ivo.quack@rub.de</email>
</contrib>
<contrib id="A2" contrib-type="author"><name><surname>Woznowski</surname>
<given-names>Magdalena</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<xref ref-type="aff" rid="I4">4</xref>
<email>magdalena.woznowski@med.uni-duesseldorf.de</email>
</contrib>
<contrib id="A3" contrib-type="author"><name><surname>Schieren</surname>
<given-names>Gisela</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<xref ref-type="aff" rid="I4">4</xref>
<email>gisela.schieren@med.uni-duesseldorf.de</email>
</contrib>
<contrib id="A4" contrib-type="author"><name><surname>Weiner</surname>
<given-names>Stefan M</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<xref ref-type="aff" rid="I5">5</xref>
<email>s.weiner@bk-trier.de</email>
</contrib>
<contrib id="A5" contrib-type="author"><name><surname>Winnekendonk</surname>
<given-names>Guido</given-names>
</name>
<xref ref-type="aff" rid="I2">2</xref>
<email>520018473130-0002@T-Online.de</email>
</contrib>
<contrib id="A6" contrib-type="author"><name><surname>Tokmak</surname>
<given-names>Faruk</given-names>
</name>
<xref ref-type="aff" rid="I3">3</xref>
<email>Faruk.Tokmak@kfh-dialyse.de </email>
</contrib>
<contrib id="A7" contrib-type="author"><name><surname>Rump</surname>
<given-names>Lars C</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<xref ref-type="aff" rid="I4">4</xref>
<email>christian.rump@med.uni-duesseldorf.de</email>
</contrib>
<contrib id="A8" corresp="yes" contrib-type="author"><name><surname>Rattensperger</surname>
<given-names>Dirk</given-names>
</name>
<xref ref-type="aff" rid="I3">3</xref>
<email>Dirk.Rattensperger@kfh-dialyse.de</email>
</contrib>
</contrib-group>
<aff id="I1"><label>1</label>
Department of Nephrology, Marienhospital Herne, Ruhr-University Bochum, Hoelkeskampring 40, 44625 Herne, Germany</aff>
<aff id="I2"><label>2</label>
Department of Radiology, Marienhospital Herne, Ruhr-University Bochum, Hoelkeskampring 40, 44625 Herne, Germany</aff>
<aff id="I3"><label>3</label>
Kuratorium für Heimdialyse und Nierentransplantation, Cruismannstrasse 37, 44807 Bochum, Germany</aff>
<aff id="I4"><label>4</label>
current address : Renal department, Heinrich-Heine University, Duesseldorf, Germany</aff>
<aff id="I5"><label>5</label>
current address : Internal Medicine 2, Nephrology, Krankenhaus Bamherzige Brueder, Trier, Germany</aff>
<pub-date pub-type="collection"><year>2007</year>
</pub-date>
<pub-date pub-type="epub"><day>3</day>
<month>12</month>
<year>2007</year>
</pub-date>
<volume>1</volume>
<fpage>164</fpage>
<lpage>164</lpage>
<ext-link ext-link-type="uri" xlink:href="http://www.jmedicalcasereports.com/content/1/1/164"></ext-link>
<history><date date-type="received"><day>2</day>
<month>8</month>
<year>2007</year>
</date>
<date date-type="accepted"><day>3</day>
<month>12</month>
<year>2007</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2007 Quack et al; licensee BioMed Central Ltd.</copyright-statement>
<copyright-year>2007</copyright-year>
<copyright-holder>Quack et al; licensee BioMed Central Ltd.</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0"></ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p>
<pmc-comment>
Quack
Ivo
ivo.quack@rub.de
Hypercalcemia after transplant nephrectomy in a hemodialysis patient: a case report
2007 Journal of Medical Case Reports 1(1): 164-. (2007) 1752-1947(2007)1:1<164> urn:ISSN:1752-1947 </pmc-comment>
</license>
</permissions>
<abstract><sec><title>Introduction</title>
<p>Hypercalcemia is a complication often seen in chronic hemodialysis patients. A rare cause of this condition is sarcoidosis. Its highly variable clinical presentation is challenging. Especially in patients suffering chronic kidney graft failure the nonspecific constitutional symptoms of sarcoidosis like fever, weight loss, arthralgia and fatigue may be easily misleading.</p>
</sec>
<sec><title>Case presentation</title>
<p>A 51 year old male developed hypercalcemia, arthralgia and B-symptoms after explantation of his kidney graft because of suspected acute rejection. The removed kidney showed vasculopathy and tubulointerstitial nephritis, which had not been overt in the biopsy taken half a year earlier. Despite explantation and withdrawal of the immunosuppression the patient's general condition deteriorated progressively. A rapid rise in serum calcium finally provoked us to check for sarcoidosis. CT scans of the lungs, broncho-alveolar-lavage and further lab tests confirmed the diagnosis.</p>
</sec>
<sec><title>Conclusion</title>
<p>This case demonstrates that withdrawal of immunosuppressive drugs sometimes unmasks sarcoidosis. It should be considered as differential diagnosis even in hemodialysis patients, in whom other reasons for hypercalcemia are much more common.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
</record>
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