A Rare and Potentially Fatal Etiology of Hypercalcemia in an Infant

Emir Tas,Vildan Tas,Manish Raisingani,Ambreen Sonawalla

doi:10.1155/2019/4270852

Emir Tas, Vildan Tas + Show 2 more

Open Access

https://doi.org/10.1155/2019/4270852

Copy DOI

Abstract

Hypercalcemia is an uncommon finding in children. Hypercalcemia has various etiologies including parathyroid dependent and independent mechanisms. Increased activity of the 1-alpha-hydroxylase enzyme in granulomatous diseases is a well-defined but an extremely rare cause of hypercalcemia in pediatric patients, particularly in infants. We describe the case of an infant who presented with failure to thrive, hepatosplenomegaly, and hypercalcemia who was initially treated with steroids but was later diagnosed with disseminated histoplasmosis in the absence of an underlying immunodeficiency. Extra caution should be used before considering steroids for the treatment of hypercalcemia and, whenever possible, steroids should not be initiated until a definite etiology is identified.

Highlights

Serum calcium level is tightly regulated as calcium is important for numerous cellular functions including cell membrane integrity, muscle contraction, and neuronal excitability [1]
Hypervitaminosis D may be from elevated levels of 25(OH)D3 concentrations, which is usually due to excess ingestion of vitamin D, or from elevated levels of 1,25(OH)2D3 which may be from malignancy, granulomatous diseases, subcutaneous fat necrosis of the newborn, or idiopathic infantile hypercalcemia [5]
The infant had to be maintained on a low calcium diet even at 3-year follow up. This is in contrast to our patient who, though was initially placed on a low calcium and vitamin D formula, did not continue to require it when the underlying cause of the hypercalcemia, the fungal infection, had been controlled

Summary

A Rare and Potentially Fatal Etiology of Hypercalcemia in an Infant

Pediatric Residency Program, University of Arkansas for Medical Sciences, Little Rock, AR, USA Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA Department of Pediatrics, Division of Endocrinology and Diabetes, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Hypercalcemia is an uncommon finding in children. Hypercalcemia has various etiologies including parathyroid dependent and independent mechanisms. Increased activity of the 1-alpha-hydroxylase enzyme in granulomatous diseases is a well-defined but an extremely rare cause of hypercalcemia in pediatric patients, in infants. We describe the case of an infant who presented with failure to thrive, hepatosplenomegaly, and hypercalcemia who was initially treated with steroids but was later diagnosed with disseminated histoplasmosis in the absence of an underlying immunodeficiency. Extra caution should be used before considering steroids for the treatment of hypercalcemia and, whenever possible, steroids should not be initiated until a definite etiology is identified

Introduction

Case Presentation

Discussion

Conclusion