Extensive metastatic calcification of the lung in an azotemic patient

Adult T-cell Leukemia with Hypercalcemia-induced Metastatic Calcification in the Lungs Due to Production of Parathyroid Hormone-related Protein.

“…Metastatic calcification is associated with abnormal calcium metabolism and is often observed in various malignancies associated with hypercalcemia and in chronic renal failure with secondary hyperparathyroidism (1)(2)(3)(4)(5)(6)(7)(8)(9). Although the frequent occurrence of hypercalcemia has been shown to be one of the mostremarkable characteristics, metastatic calcification in the lungs is not commonin the patients with ATL(10-19).…”

“…In the present case, the elevated serum PTHrP level was probably involved mainly in the mechanism of hypercalcemia. The lung is the most frequent visceral site of metastatic calcification (4,5). Deposition occurs in the alveolar septae and/ or the alveolar space.…”

“…In addition, worsening renal insufficiency superimposed on abnormalities in calcium and phosphate metabolismcould aggravate the deposition of calcium salts. Metastatic calcification in the lungs presents various roentgenographic changes such as diffuse and focal infiltration mimicking pneumonia, a pattern resembling pulmonary edemaand interstitial change, or an absence of abnormalities; therefore, such calcification is rarely recognized clinically (2)(3)(4)(5)(6)(7)(8)(9)17). In most of the reported cases, the diagnosis was madeby postmortempathology without clinical or roentgenologic evidence of disease.…”

“…Metastatic calcification occurs in disorders of calcium metabolism without prior tissue damageand is often associated with various malignancies and chronic renal failure (1)(2)(3)(4)(5)(6)(7)(8)(9). Hypercalcemia is a commoncomplication of adult T-cell leukemia (ATL), and several cases of metastatic calcification in the lungs have been reported in such patients (10)(11)(12)(13)(14)(15)(16)(17).…”

“…Hypercalcemia is a commoncomplication of adult T-cell leukemia (ATL), and several cases of metastatic calcification in the lungs have been reported in such patients (10)(11)(12)(13)(14)(15)(16)(17). Metastatic calcification of the lungs is knownto showvarious roentgenographic changes (2)(3)(4)(5)(6)(7)9). In this report, we present a case of ATLwith respiratory insufficiency and a chest roentgenogram suggestive of pneumonic infiltration caused by severe hypercalcemia-induced metastatic calcification in the lungs due to production of parathyroid hormone-related protein (PTHrP).…”