Case ReportHypercalcemia Associated with Mineral Oil-Induced Sclerosing Paraffinomas
Section snippets
INTRODUCTION
Hypercalcemia occurs in a variety of chronic granu-lomatous diseases such as sarcoidosis, berylliosis, slack skin granulomatous disease, Crohns disease, and certain lymphomas (1,2). The mechanism for the hypercalcemia in these diseases has been demonstrated to be increased circulating levels of dihydroxyvitamin D [1,25(OH)2D] (3) catalyzed by autonomous activity of 25-hydroxyvitamin D3 1-alpha hydroxylase (CYP27b1) (4). This enzyme is also known to be expressed by a variety of extra-renal
DISCUSSION
Extensive diagnostic evaluation of this patient's symptomatic hypercalcemia was unrevealing for the most common etiologies of hypercalcemia. Symptomatic hyper-calcemia developed 8-10 years after the appearance of mineral oil-associated skin lesions. Sarcoidosis, especially with elevated angiotensin-converting enzyme (ACE) levels is a difficult diagnosis to exclude, but the lack of suggestive history, physical, or radiographic signs make the diagnosis of sarcoidosis unlikely. Furthermore,
METHODS
Informed consent was obtained from the patient for immunostaining of skin tissue from the skin biopsy site. After approval from the Institutional Review Board and Biospecimens Subcommittee of the New York Downtown Hospital, immunohistochemical analysis of Cyp27b1 protein expression in paraffin-embedded tissue sections was carried out. Hormonal tests were performed by routine, commercial assays. For 25-OH-D, liquid chromatogra-phy-tandem mass spectrometry was used as described below: Deuterated
DISCLOSURE
The authors have no multiplicity of interest to disclose. This work was funded by the New York Downtown Hospital and the UCLA Orthopaedic Hospital Research Center.
ACKNOWLEDGMENT
The authors thank Dr. Cynthia Magro (Professor of Pathology and Laboratory Medicine at the Weill Cornell Medical College) for reviewing the skin biopsy.
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