Acute respiratory distress syndrome driven by severe hypercalcemia and acute kidney injury: A case report and literature review of a rare, life-threatening complication

Abstract

Acute respiratory distress syndrome (ARDS) is a rare and under-reported complication of hypercalcemia, which often presents in conjunction with acute kidney injury (AKI). Unfamiliarity with the condition inevitably leads to management uncertainty, resulting in fatal outcomes. Early identification, however, confers a good prognosis. We report a case of a 40-year-old male who presented with severe hypercalcemia and AKI and rapidly deteriorated due to ARDS, with no evidence of cardiogenic pulmonary edema or fluid overload. Infection screens were negative. He died despite invasive ventilation and continuous venous-venous hemofiltration. His autopsy revealed extensive metastatic pulmonary calcifications and alveolar edema. We found only 10 other cases of hypercalcemia-induced ARDS in the literature, with only 2 patients surviving. We provide the first literature review on the subject to guide the management of this rare but fatal complication, which can be managed with good outcomes if considered early.

The potential link between Covid‐19 and multiple myeloma: A new saga

“…The underlying mechanism of ARDS in MM is not fully understood; however, hypercalcemia, a common complication in MM, may deposit in the alveolar basement membrane with subsequent induction of inflammation and capillary permeability. 30 In addition, proteasome dysfunction in the alveolar type 2 epithelial cells increases the risk for ARDS development due to a reduction in the alveolar epithelial barrier function and formation of surfactants. 31 Proteasome dysfunction is highly evident in MM, 32 which could potentially cause ARDS development in MM.…”

“…These observations indicated that extramedullary manifestations of MM in the lung might lead to ARDS progression. The underlying mechanism of ARDS in MM is not fully understood; however, hypercalcemia, a common complication in MM, may deposit in the alveolar basement membrane with subsequent induction of inflammation and capillary permeability 30 . In addition, proteasome dysfunction in the alveolar type 2 epithelial cells increases the risk for ARDS development due to a reduction in the alveolar epithelial barrier function and formation of surfactants 31 .…”

A rare case of acute respiratory distress syndrome driven by parathyroid storm: a case report

“…Symptomatic hypercalcemia can manifest on a clinical spectrum, with ARDS being a particularly rare and likely underreported presentation. Despite the prevalence of hypercalcemia, only a few true cases of hypercalcemia-induced ARDS have been reported in the literature [3]. Only three cases of ARDS related to parathyroid crisis have been reported since 1974 [4].…”