Refractory hypercalcemia in an infant secondary to talc pleurodesis resolving after renal transplantation

S. J. Aujla, P. Michelson, C. B. Langman, R. Shapiro, D. Ellis, M. L. Moritz

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Talc pleurodesis is the definitive therapy of recurrent pneumothorax and has not been associated with metabolic complications. We report an anephric male infant who developed severe hypercalcemia 6 months following talc pleurodesis for recurrent peritoneal dialysis-related hydrothorax. The etiology of hypercalcemia was related to persistently elevated 1,25-dihyroxyvitamin D 3 (1,25[OH]2D) levels. The source appeared to be the extrarenal production of 1,25(OH)2D from macrophages in a large thoracic talc granuloma. Hypercalcemia was controlled with a combination of a low calcium diet, low calcium dialysis, ketoconazole and hydroxychloroquine, but elevated 1,25(OH)2D levels persisted. At 32 months of age the child underwent renal transplantation with alemtuzumab pre-conditioning. The hypercalcemia resolved immediately, with normalization of serum 1,25(OH) 2D levels and without hypercalciuria. This case demonstrates that hypercalcemia is a potential complication of talc pleurodesis from the extrarenal production of 1,25(OH)2D and that alemtuzumab, a monoclonal antibody directed against the CD52 antigen (which is expressed on almost all macrophages), may have a role in the treatment of hypercalcemia associated with granulomatous conditions.

Original languageEnglish (US)
Pages (from-to)1329-1333
Number of pages5
JournalAmerican Journal of Transplantation
Volume8
Issue number6
DOIs
StatePublished - Jun 2008

Keywords

  • Alemtuzumab
  • Calcium
  • Dialysis
  • Hypercalcemia
  • Pediatric nephrology
  • Vitamin D

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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