Hypercalcemia Due to Elevated 1,25 Dihydroxyvitamin D in Tophaceous Gout A Rare Case Report

Introduction

Hypercalcemia is a common clinical condition, often associated with primary hyperparathyroidism and malignancy. However, rare causes such as granulomatous diseases can lead to excessive production of 1,25-dihydroxyvitamin D, resulting in hypercalcemia. While tophaceous gout is not typically linked to this mechanism, emerging case reports suggest otherwise.

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Case Summary

A 68-year-old male with a longstanding history of chronic tophaceous gout presented with persistent hypercalcemia (13.1 mg/dL) and worsening renal function. Despite an extensive work-up, common causes of hypercalcemia, including malignancy and sarcoidosis, were ruled out. The patient’s serum 1,25-dihydroxyvitamin D was significantly elevated at 87.5 pg/mL (normal: 22-67 pg/mL), suggesting unregulated extrarenal activation. The presence of extensive granulomas within the gouty tophi was identified as the likely culprit.

Key Findings

• Extensive tophi with granulomatous inflammation confirmed via biopsy.
• Elevated serum calcium and 1,25-dihydroxyvitamin D, indicative of abnormal macrophage activity within granulomas.
• Negative malignancy and infectious work-up, ruling out other granulomatous diseases such as sarcoidosis and tuberculosis.
• Successful treatment with prednisone, leading to normalized calcium and vitamin D levels.

External Medical Perspective

According to the American College of Rheumatology (ACR), early recognition and management of tophaceous gout are crucial in preventing severe complications, including systemic effects such as hypercalcemia.

Link to Full Study

For an in-depth analysis, read the full study at https://doi.com/10.29328/journal.jcn.1001143.

Implications and Conclusion

This case highlights the importance of considering tophaceous gout as a potential rare cause of hypercalcemia. The excessive production of 1,25-dihydroxyvitamin D within granulomatous tophi can mimic other granulomatous disorders, emphasizing the need for thorough differential diagnosis.

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