PMID- 30627599
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210621
IS  - 2352-1872 (Print)
IS  - 2352-1872 (Electronic)
IS  - 2352-1872 (Linking)
VI  - 10
DP  - 2019 Jun
TI  - Rapid onset of hypercalcemia from high-grade lymphoma in the setting of 
      HIV-related immune reconstitution inflammatory syndrome.
PG  - 100194
LID - 10.1016/j.bonr.2018.100194 [doi]
LID - 100194
AB  - Hypercalcemia in HIV patients has been previously reported, but 1,25-(OH)(2) 
      vitamin D-mediated hypercalcemia, due to increased activity of extrarenal 1-alpha 
      hydroxylase, is rarely described with HIV-related infections or malignancies. We 
      describe a case of 1,25-(OH)(2) vitamin D-mediated hypercalcemia in a patient 
      presenting with progressive cognitive decline and weakness. Initial evaluation 
      revealed a new diagnosis of HIV, for which he was started on antiretroviral 
      therapy (ART). He was also noted to have mild asymptomatic hypocalcemia, likely 
      from his acute illness and malnutrition, which was not further investigated at 
      the time. While the patient's mental status initially improved with ART, he 
      became progressively delirious and was found to be hypercalcemic approximately 
      4 weeks after the initiation of ART. Possible etiologies for hypercalcemia were 
      vigorously evaluated, including granulomatous disease, infection, and malignancy, 
      in the setting of suspected immune reconstitution inflammatory syndrome (IRIS), 
      due to recent initiation of ART. Infectious workup was unrevealing, but computed 
      tomography (CT) of the chest, abdomen, and pelvis revealed new extensive diffuse 
      lymphadenopathy and hepatomegaly, not present on admission studies. Cytology and 
      flow cytometry of a liver biopsy specimen revealed CD10 positive high-grade 
      B-cell lymphoma. Chemotherapy was not pursued due to poor performance status. 
      Over the next week, spontaneous tumor lysis developed, and the patient expired. 
      Postmortem, his 1,25-(OH)(2) vitamin D level returned as markedly elevated. 
      Immunohistochemical staining of his liver biopsy tissue showed strong expression 
      of CYP27B1. 1,25-(OH)(2) vitamin D-mediated hypercalcemia is uncommon in a 
      patient with newly diagnosed HIV and, in this case, was likely due to IRIS 
      unmasking an underlying high-grade lymphoma and restoration of immune function 
      (including T-cells and cytokine production). This case emphasizes the importance 
      of including aggressive lymphomas, capable of progressing over days to weeks, in 
      the evaluation of hypercalcemia in HIV patients at risk for developing IRIS and 
      the rapid dynamic changes in mineral homeostasis that can occur with such an 
      aggressive tumor in an immunocompromised host.
FAU - Kim, Stephanie J
AU  - Kim SJ
AD  - Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, 
      University of California, San Francisco, United States of America.
FAU - Peluso, Michael J
AU  - Peluso MJ
AD  - Division of Infectious Disease, Department of Medicine, University of California, 
      San Francisco, United States of America.
AD  - Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, 
      Zuckerberg San Francisco General Hospital, United States of America.
FAU - Wang, Yongmei
AU  - Wang Y
AD  - Endocrine Research Unit, Department of Medicine, San Francisco Veterans Affairs 
      Health Care System, United States of America.
FAU - Bikle, Daniel
AU  - Bikle D
AD  - Endocrine Research Unit, Department of Medicine, San Francisco Veterans Affairs 
      Health Care System, United States of America.
FAU - Shoback, Dolores
AU  - Shoback D
AD  - Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, 
      University of California, San Francisco, United States of America.
AD  - Endocrine Research Unit, Department of Medicine, San Francisco Veterans Affairs 
      Health Care System, United States of America.
FAU - Kim, Sarah
AU  - Kim S
AD  - Division of Endocrinology and Metabolism, Department of Medicine, Zuckerberg San 
      Francisco General Hospital, United States of America.
LA  - eng
GR  - I01 BX001066/BX/BLRD VA/United States
GR  - I01 BX003814/BX/BLRD VA/United States
GR  - I01 CX001514/CX/CSRD VA/United States
PT  - Case Reports
DEP - 20181228
PL  - United States
TA  - Bone Rep
JT  - Bone reports
JID - 101646176
EIN - Bone Rep. 2021 Apr 30;14:101086. PMID: 34150957
PMC - PMC6319307
OTO - NOTNLM
OT  - 1,25-(OH)2 vitamin D
OT  - HIV
OT  - Hypercalcemia
OT  - Immune reconstitution inflammatory syndrome
OT  - Lymphoma
EDAT- 2019/01/11 06:00
MHDA- 2019/01/11 06:01
PMCR- 2018/12/28
CRDT- 2019/01/11 06:00
PHST- 2018/09/19 00:00 [received]
PHST- 2018/11/21 00:00 [revised]
PHST- 2018/12/27 00:00 [accepted]
PHST- 2019/01/11 06:00 [entrez]
PHST- 2019/01/11 06:00 [pubmed]
PHST- 2019/01/11 06:01 [medline]
PHST- 2018/12/28 00:00 [pmc-release]
AID - S2352-1872(18)30064-0 [pii]
AID - 100194 [pii]
AID - 10.1016/j.bonr.2018.100194 [doi]
PST - epublish
SO  - Bone Rep. 2018 Dec 28;10:100194. doi: 10.1016/j.bonr.2018.100194. eCollection 
      2019 Jun.