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Abstract: FR-PO549

A Queer Case of Rapidly Progressive Metastatic Pulmonary Calcification (MPC) in a Patient with ESRD: Are We Doing Enough?

Session Information

Category: Trainee Case Report

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Abbas, Ramla, Orange Park Medical Center, Orange Park, Florida, United States
  • Zahid, Hasan, Orange Park Medical Center, Orange Park, Florida, United States
  • Aftab, Ghulam Mustafa, Orange Park Medical Center, Orange Park, Florida, United States
  • Kotihal, Ramesh M., Nephrology Associates of NE Florida, Orange Park, Florida, United States
Introduction

Metastatic pulmonary calcification (MPC) is a metabolic lung disease which is poorly understood and can prove fatal. Despite its high prevalence, it remains undetected. We describe a case of MPC in a young female patient with ESRD which ultimately lead to patient's demise.

Case Description

A 32 year old female with history of end stage renal disease (ESRD) secondary to autosomal dominant polycystic kidney disease presented with generalized weakness for 2 months. She had been on hemodialysis (HD) for 3 years but was not compliant with dialysis. Physical exam was grossly unremarkable and vital signs were within normal limits. Relevant laboratory findings included BUN of 73 mg/dl, Cr of 11.7 mg/dl, phosphorus of 8.2 mg/dl, calcium of 11.1 mg/dl and PTH was 1284 pg/ml. Broad spectrum antibiotics were initiated. Few hours into admission, she rapidly deteriorated, became confused and was subsequently intubated and transferred to the Intensive Care Unit. High Resolution CT scan of the chest showed very dense airspace opacification (measuring a mean attenuation of 329 HU), involving the right middle lobe and left upper lobe (including the lingula) with patchy dense opacification elsewhere. Patient remained afebrile. Blood cultures, sputum cultures, tuberculosis quantiferon and bronchoalveolar lavage were negative for any infection. Technetium (Tc) 99 bone scan disclosed diffuse activity in the pulmonary parenchyma, strongly supporting metastatic pulmonary calcification Despite escalating supportive measures, the patient became increasingly hypoxic and died 4 days later.

Discussion

In contrast to other conditions leading to death in ESRD patients, metastatic pulmonary calcification does not usually cause symptoms, can result in quick respiratory decline and is often identified only at autopsy as routine chest X-rays are mostly negative. MPC may remain undiagnosed and untreated, at times progressing to severe acute respiratory failure. It is of paramount importance that we not only do timely detection and treatment but also explore new diagnostic and therapeutic methods for MPC to decrease overall mortality in ESRD patients.