Hypercalcemia due to Elevated 1,25 dihydroxyvitamin D in Tophaceous Gout - Case Report and Literature Review
Article Sidebar
Main Article Content
Abstract
Granulomatous diseases can cause hypercalcemia due to elevated 1,25-dihydroxyvitamin D through the production of 1-α hydroxylase by macrophages in the granulomas. Tophaceous gout is not considered to cause this picture. However, there are a few case reports of this occurrence in tophaceous gout, as well as the description of intense 1-α hydroxylase activity in granulomas of tophi in gout patients. We review this literature, and we report a well-documented case of hypercalcemia with elevated serum 1,25 dihydroxyvitamin D in a patient with extensive tophaceous gout and tophi loaded with granulomas. An extensive work-up ruled out other causes of hypercalcemia and granulomatous diseases. Prednisone corrected the chemical abnormalities. Diffuse tophaceous gout should be considered a rare cause of hypercalcemia due to excessive 1,25 dihydroxy vitamin D.
Article Details
Copyright (c) 2024 Ahmad M, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Journal of Clinical Nephrology is committed in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. In order to use the Open Access paradigm to the maximum extent in true terms as free of charge online access along with usage right, we grant usage rights through the use of specific Creative Commons license.
License: Copyright © 2017 - 2025 | 
Open Access by Journal of Clinical Nephrology is licensed under a Creative Commons Attribution 4.0 International License. Based on a work at Heighten Science Publications Inc.
With this license, the authors are allowed that after publishing with the journal, they can share their research by posting a free draft copy of their article to any repository or website.
Compliance 'CC BY' license helps in:
| Permission to read and download | ✓ |
| Permission to display in a repository | ✓ |
| Permission to translate | ✓ |
| Commercial uses of manuscript | ✓ |
'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.
Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.
Walker MD, Shane E. Hypercalcemia: A review. JAMA. 2022;328(16):1624–1636. Available from: https://doi.org/10.1001/jama.2022.18331
Goltzman D. Pathophysiology of hypercalcemia. Endocrinol Metab Clin North Am. 2021;50(4):591-607. Available from: https://doi.org/10.1016/j.ecl.2021.07.008
Motlaghzadeh Y, Bilezikian JP, Sellmeyer DE. Rare causes of hypercalcemia: 2021 update. J Clin Endocrinol Metab. 2021;106(11):3113-3128. Available from: https://doi.org/10.1210/clinem/dgab504
Ungprasert P, Carmona EM, Crowson CS, Matteson EL. Diagnostic utility of angiotensin-converting enzyme in sarcoidosis: A population-based study. Lung. 2016;194(1):91-5. Available from: https://doi.org/10.1007/s00408-015-9826-3
Jacobs TB, Bilezikian JP. Rare causes of hypercalcemia. J Clin Endocrinol Metab. 2005;90:6316–6322. Available from: https://doi.org/10.1210/jc.2005-0675
Gallegos-Bayas G, Pascual-Pareja JF, Sanchez-Niño MD, Manzarbeitia F, Ortiz A. Undetectable serum calcidiol: Not everything that glitters is gold. Clin Kidney J. 2012;5(1):37-40. Available from: https://doi.org/10.1093/ndtplus/sfr121
Rodríguez-Gutiérrez R, Zapata-Rivera MA, Rodriguez-Velver KV, Lavalle-Gonzalez FJ, Gonzalez-Gonzalez JG, Villarreal-Perez JZ. Severe hypercalcemia - Chronic tophaceous gout as the responsible cause? Eur Endocrinol. 2015;11(2):102-104. Available from: https://doi.org/10.17925/ee.2015.11.02.102
Sachdeva A, Goeckeritz BE, Oliver AM. Symptomatic hypercalcemia in a patient with chronic tophaceous gout: A case report. Cases J. 2008;1(1):72. Available from: https://doi.org/10.1186/1757-1626-1-72
Hasbani GE, Megahed A, Cassetta M. When tophaceous gout involves multiple organs: Challenges and solutions. Acta Endocrinol (Buchar). 2023;19(1):131-132. Available from: https://doi.org/10.4183/aeb.2023.131
Lee KA, Yoo WH. Immobilization hypercalcemia-associated acute renal failure in a patient with chronic tophaceous gout. Ren Fail. 2009;31(9):855-7. Available from: https://doi.org/10.3109/08860220903151393
Gudlawar S. Hypercalcemia associated with severe tophaceous gout. Fluids, Electrolytes, and Acid-base Disorders: Clinical. 2023 Nov 4. Pennsylvania. SA-PO965. Available from: https://journals.lww.com/jasn/citation/2023/11001/hypercalcemia_associated_with_severe_tophaceous.3249.aspx
Oelzner P, Lehmann G, Eidner T, Franke S, Müller A, Wolf G, Hein G. Hypercalcemia in rheumatoid arthritis: Relationship with disease activity and bone metabolism. Rheumatol Int. 2006;26(10):908-15. Available from: https://doi.org/10.1007/s00296-005-0095-y