Metastatic Pulmonary Calcification in Multiple Myeloma in a 45-Year-Old Man

Abstract

Metastatic calcification has been associated with multiple-myeloma-induced hypercalcemia. Despite of a relatively high prevalence of metastatic pulmonary calcification in patients with multiple myeloma, only a few cases have been clinically and radiologically detected. A 45-year-old Hispanic male presented to the Emergency Department with complaint of worsening weakness and myalgia. Laboratory findings revealed renal insufficiency and hypercalcemia. CT scan of chest revealed calcified pleural and pulmonary nodule. Technetium (Tc) 99 bone scan revealed diffuse activity in the pulmonary parenchyma consistent with metastatic pulmonary calcification. Metastatic pulmonary calcification, despite its high prevalence, remains undetected. This is, in part, due to its radiographic characteristic properties that evade detection by routine imaging studies. We present a case of a metastatic pulmonary calcification in a patient diagnosed with multiple myeloma and chronic kidney disease, as well as a brief literature review including clinical findings and treatment options.

Metastatic pulmonary calcification: State-of-the-art review focused on imaging findings

“…Isolated hyperphosphatemia and tertiary hyperparathyroidism may also be treated with phosphate binders [9]. Prompt management of secondary and tertiary hyperparathyroidism is necessary to avoid uncontrolled extraskeletal calcification, ischemic skin necrosis, pruritis, and hyperparathyroid bone disease [61].…”

“…Prompt management of secondary and tertiary hyperparathyroidism is necessary to avoid uncontrolled extraskeletal calcification, ischemic skin necrosis, pruritis, and hyperparathyroid bone disease [61]. Therapy with calcium and vitamin D supplementation is initiated, and parathyroidectomy is indicated if the condition is unresponsive to medical therapy [9].…”

Radiological and Clinical Manifestations of Metastatic Pulmonary Calcification in a Patient with Parathyroid Hyperplasia

“…Metastatic calcification is a deposition of calcium salts in normal tissue. It occurs most commonly in the lungs, kidneys, gastric mucosa, heart, and vessel walls (3). MPC can be caused by chronically elevated serum calciumphosphorus levels, as in chronic renal failure, primary and secondary hyperparathyroidism, hypervitaminosis D, milkalkali syndrome, or diffuse myelomatosis (2,3).…”

“…(4). However, irreversible lung damage and respiratory failure can develop in untreated patients (3).…”

Noninfectious Causes of Diffuse Pulmonary Infiltrations in Chronic Renal Failure: Metastatic Pulmonary Calsification

“…Calcium phosphate crystals come into existence on necrotic or inflamed cells. Uncommonly, MPC is seen in patients with normal renal functions, normal calcium and phosphate levels and without underlying lung disease [1][2][3][4][5][6][7][8][9][10]. Chest radiographs of MPC reveal multiple diffuse calcified nodulesand confluent or patchy airspace opacities simulating diffuse interstitial process, pulmonary edema, pneumonia, alveolar hemorrhage, hypersensitivity pneumonitis, vasculitis, sarcoidosis, chronic eosinophilic pneumonia, occupational lung disease and pulmonary alveolar microlithiasis [11,12].…”