Acquired perforating calcific collagenosis in a drug addict with rhabdomyolysis and transient hypercalcemia

Wang, Fang-Ying; Ng, Chau Yee; Wu, Jennifer; Kuo, Kang-Ling; Chang, Yung‐Yee; Kuo, Tseng‐Tong

doi:10.1111/cup.13371

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…The prevalence of hypercalcaemia in rhabdomyolysis is quoted to be between 9.2 and 34% ( 6 , 7 , 8 ). The variable prevalence is probably related to incomplete identification of these subjects due to the late occurrence of hypercalcaemia (often in the polyuric or recovery phase of AKI) and its mild, often asymptomatic nature.…”

Section: Discussionmentioning

confidence: 99%

Myositis, rhabdomyolysis and severe hypercalcaemia in a body builder

Ravindran

Witczak

Bahl

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary A 53-year-old man who used growth hormone (GH), anabolic steroids and testosterone (T) for over 20 years presented with severe constipation and hypercalcaemia. He had benign prostatic hyperplasia and renal stones but no significant family history. Investigations showed – (1) corrected calcium (reference range) 3.66 mmol/L (2.2–2.6), phosphate 1.39 mmol/L (0.80–1.50), and PTH 2 pmol/L (1.6–7.2); (2) urea 21.9 mmol/L (2.5–7.8), creatinine 319 mmol/L (58–110), eGFR 18 mL/min (>90), and urine analysis (protein 4+, glucose 4+, red cells 2+); (3) creatine kinase 7952 U/L (40–320), positive anti Jo-1, and Ro-52 antibodies; (4) vitamin D 46 nmol/L (30–50), vitamin D3 29 pmol/L (55–139), vitamin A 4.65 mmol/L (1.10–2.60), and normal protein electrophoresis; (5) normal CT thorax, abdomen and pelvis and MRI of muscles showed ‘inflammation’, myositis and calcification; (6) biopsy of thigh muscles showed active myositis, chronic myopathic changes and mineral deposition and of the kidneys showed positive CD3 and CD45, focal segmental glomerulosclerosis and hypercalcaemic tubular changes; and (7) echocardiography showed left ventricular hypertrophy (likely medications and myositis contributing), aortic stenosis and an ejection fraction of 44%, and MRI confirmed these with possible right coronary artery disease. Hypercalcaemia was possibly multifactorial – (1) calcium release following myositis, rhabdomyolysis and acute kidney injury; (2) possible primary hyperparathyroidism (a low but detectable PTH); and (3) hypervitaminosis A. He was hydrated and given pamidronate, mycophenolate and prednisolone. Following initial biochemical and clinical improvement, he had multiple subsequent admissions for hypercalcaemia and renal deterioration. He continued taking GH and T despite counselling but died suddenly of a myocardial infarction. Learning points: The differential diagnosis of hypercalcaemia is sometimes a challenge. Diagnosis may require multidisciplinary expertise and multiple and invasive investigations. There may be several disparate causes for hypercalcaemia, although one usually predominates. Maintaining ‘body image’ even with the use of harmful drugs may be an overpowering emotion despite counselling about their dangers.

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Section: Discussionmentioning

confidence: 99%

Myositis, rhabdomyolysis and severe hypercalcaemia in a body builder

Ravindran

Witczak

Bahl

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…Associations with immunobullous diseases have also been noted [ 50 , 51 , 52 ]. Less common associations include pregnancy [ 53 , 54 ], non-red tattoos [ 55 ], MRSA [ 56 ], copper deficiency [ 57 ], Down’s syndrome [ 58 ], and rhabdomyolysis-related hypercalcemia [ 59 ]. One report noted acquired perforating dermatosis in a pair of siblings [ 60 ], suggesting that there may be a genetic component involved in the etiology.…”

Section: Discussionmentioning

confidence: 99%

Perforating Gout: Expanding the Differential for Transepidermal Elimination

Bohdanowicz

Bradshaw

2023

Dermatopathology

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Perforating dermatoses are dermatologic disorders with transepidermal elimination (TE) of dermal substances. While TE is typically associated with collagen and elastin, it can also occur as a secondary event in other processes, and it is important to keep a broad differential. We present a case of perforating tophaceous gout, which underscores the need for a thoughtful approach to perforating disorders. An updated review of recent literature is also presented.

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“…Associations with immunobullous diseases have also been noted [50][51][52]. Less common associations include pregnancy [53,54], non-red tat-toos [55], MRSA [56], copper deficiency [57], Down's syndrome [58], and rhabdomyolysisrelated hypercalcemia [59]. One report noted acquired perforating dermatosis in a pair of siblings [60], suggesting that there may be a genetic component involved in the etiology.…”

Section: Review Of Recent Literaturementioning

confidence: 99%