Faculty Collaboration Database

Active crohn disease and hypercalcemia treated with infliximab: case report and literature review. Endocr Pract 2008;14(1):87-92

Date

02/02/2008

Pubmed ID

18238746

DOI

10.4158/EP.14.1.87

Scopus ID

2-s2.0-40649123073 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

OBJECTIVE: To report a case of 1,25-dihydroxyvitamin D-mediated hypercalcemia caused by active Crohn disease that improved with infliximab therapy.

METHODS: We present the clinical and laboratory findings and describe the clinical course of a patient who had hypercalcemia during Crohn disease exacerbations. The literature is reviewed regarding 1,25-dihydroxyvitamin D production in Crohn disease, and the 3 cases of hypercalcemia in individuals with Crohn disease reported in the literature are described.

RESULTS: A 50-year-old man with long-standing Crohn disease treated with multiple bowel resections presented for take-down ileostomy. He was hypercalcemic and had suppressed parathyroid hormone and parathyroid hormone-related peptide levels. Histopathology of the resected ileostomy site and adjacent small bowel indicated active Crohn disease. Hypercalcemia promptly resolved after a few days of treatment with intravenous glucocorticoids. One month later, hypercalcemia recurred in the presence of an inappropriately high 1,25-dihydroxyvitamin D level and increased urinary calcium and serum angiotensin-converting enzyme levels. The serum and urinary calcium levels became normal with infliximab therapy. Three previous reports of hypercalcemia caused by active Crohn disease describe effective treatment with glucocorticoids. This is the first report of successful response to infliximab in this setting.

CONCLUSION: Hypercalcemia mediated by 1,25-dihydroxyvitamin D in the setting of Crohn disease may respond to glucocorticoid-sparing immunomodulators.

Author List

Ioachimescu AG, Bauer TW, Licata A

Author

Adriana G. Ioachimescu MD, PhD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anti-Inflammatory Agents
Antibodies, Monoclonal
Calcitriol
Calcium
Crohn Disease
Humans
Hypercalcemia
Infliximab
Male
Middle Aged
Parathyroid Hormone
Vitamin D