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JAMA. 1998 Feb 18;279(7):532-4.

Hypercalcemia due to endogenous overproduction of active vitamin D in identical twins with cat-scratch disease.

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1
Internal Medicine Unit, Hospital Casa Maternitat, Corporació Sanitària Clinic, Barcelona, Spain.

Abstract

CONTEXT:

The extrarenal synthesis of active vitamin D sterols has a central causative role in the hypercalcemia associated with various granulomatous diseases.

OBJECTIVE:

To study the calcium metabolism in patients with cat-scratch disease who have hypercalcemia.

DESIGN:

Case report.

SETTING:

University hospital in Barcelona, Spain.

PATIENTS:

Two identical twins who developed asymptomatic hypercalcemia during the acute phase of cat-scratch disease.

MAIN OUTCOME MEASURES:

Serial measures of calcium homeostasis and metabolism over a 2-month period.

RESULTS:

On admission and 6 and 7 days later, both patients were found to have increased levels of serum and urinary calcium, serum phosphate, and serum 1,25-dihydroxyvitamin D [1,25(OH)2D], whereas they had normal values of serum 25-hydroxyvitamin D and urinary cyclic adenosine monophosphate and decreased serum concentrations of intact parathyroid hormone. Sixteen and 20 days after admission, these abnormalities had resolved without treatment. A direct correlation was observed between the serum 1,25(OH)2D levels and both the serum and 24-hour urinary calcium concentrations. Also, the concentrations of calcium and 1,25(OH)2D paralleled the clinical activity of the infectious disease over the period these parameters were measured.

CONCLUSIONS:

Our cases provide evidence that cat-scratch disease can produce hypercalcemia through the unregulated production of the metabolite 1,25(OH)2D. Cat-scratch disease should be added to the list of granuloma-forming diseases that are responsible for 1,25(OH)2D-mediated hypercalcemia.

PMID:
9480364
[Indexed for MEDLINE]
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