高カルシウム血症を合併したサルコイドーシスの1例 : 肺組織中の1α,25-dihydroxyvitamin D含量増加について  [in Japanese] Sarcoidosis with Hypercalcemia and Increased 1α, 25-dihydroxyvitamin D in Lung Tissue  [in Japanese]

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Abstract

高カルシウム血症を合併したサルコイドーシスの1症例 (60歳女性) を報告した. 血清力ルシウム値は12.6mg/dl (補正値12.4) と上昇し, 皮疹および胸部X線写真上のびまん性粒状影を認めた. プレドニゾロン (40mg/日) を投与開始したところ, 血清カルシウム値の正常化と胸部X線写真上の陰影の改善が認められた. 高カルシウム血症の原因は, 肉芽腫における1α, 25-dihydroxyvitamin Dの産生亢進によると説明されているが, 本症例では経気管支肺生検組織中の1α, 25-dihydroxyvitamin D含量が対照サルコイドーシス患者のそれと比べて増加していた. 高カルシウム血症を合併したサルコイドーシス症例の報告は本邦では少なく, 本症例における高カルシウム血症の合併に関して, ヒト白血球抗原 (HLA) との関連, さらにビタミンD過剰摂取との関連の可能性について考察を加えた.

A 60-year-old woman was admitted to our hospital complaining of nausea, thirst, and dyspnea on exertion. She had skin eruptions on her back and right knee. Her serum calcium level was 12.6mg/dl. The chest roentgenogram showed diffuse nodular shadows in both lung fields. The level of angiotensin-converting enzyme in serum was markedly high, and epithelioid cell granulomas were found in the specimens obtained by skin biopsy and by transbronchial lung biopsy. Sarcoidosis was diagnosed. After administration of prednisolone, the serum calcium level decreased to within the normal range and the shadows on the chest roentcenogram resolved.<br>Hypercalcemia complicated with sarcoidosis is caused by overproduction of 1α, 25-dihydroxyvitamin D in granulomas. The content of 1α, 25-dihydroxyvitamin D in the transbronchial lung biopsy specimen from this patient was higher than that from a sarcoidosis patient whose serum calcium level was normal.<br>A few case reports of sarcoidosis with hypercalcemia have been published in Japan. The association with HLA type and the possibility of overintake of dietary vitamin D are discussed in reference to hypercalcemia in this patient.

Journal

  • The Japanese journal of thoracic diseases

    The Japanese journal of thoracic diseases 33(8), 900-905, 1995-08-25

    The Japanese Respiratory Society

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