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Abstract: PO0583

A Rare Cause of Reversible Granulomatous Lung Disease Leading to Hypercalcemia in a Peritoneal Dialysis Patient

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Shrestha, Sanjeev, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Zaidi, Raza, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Schuerch, Conrad, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Singh, Gurmukteshwar, Geisinger Medical Center, Danville, Pennsylvania, United States
Introduction

Hypercalcemia is associated with poor outcomes in patients with end-stage kidney disease (ESKD). A meticulous work-up is essential to deduce the etiology and initiate appropriate management. We present a report where comprehensive work-up revealed a rare, environmental exposure as a cause of hypercalcemia: exposure to drywall dust.

Case Description

A 59-year-old man with ESKD had longstanding well-controlled mineral bone disorder. He developed worsening hyperphosphatemia of unclear etiology, and eventually presented with symptomatic hypercalcemia with corrected calcium level of 12.9 mg/dL. Biochemistry and imaging were consistent with hypercalcemia of granulomatous lung disease. CT chest showed numerous conglomerations of centrilobular nodules in multiple lobes of both lungs (Figure 1A). Transbronchial biopsy showed giant cell granulomas containing crystalline material and calcified inclusions (Figure 1C, 1D). Infectious and rheumatological work-up was unrevealing. Detailed patient interview revealed that he had been sanding drywall without respiratory protection due to N95 mask shortage in the global pandemic. No treatment was initiated because the environmental exposure had already terminated. Over a few months, the imaging (Figure 1B) and biochemical findings resolved. A year later, the patient has well controlled mineral bone disorder on calcium-containing phosphate binders again.

Discussion

Our report demonstrates how systematic work-up and careful history-taking are critical in diagnosing esoteric conditions associated with hypercalcemia. It also illustrates indirect health-related effects of the coronavirus-19 pandemic on non-infected ESKD patients.

A: CT scan showing granulomas, B: Resolution of granulomas in 4 months, C: Transbronchial biopsy with granulomatous inflammation, D: Crystalline material in granulomas