Metastatic Pulmonary Calcification With Coexisting Nonspecific Interstitial Pneumonia: A Case Report

Abstract

Abstract Patients with underlying chronic kidney disease (CKD) often have elevated serum calcium and parathyroid hormones due to compromised kidney function. We present a case of a 63-year-old female nonsmoker with surgical history of three renal transplants (at age 47, 51, and 58) along with thyroidectomy and parathyroidectomy who came to the emergency department with complaint of persistent dry cough and shortness of breath for the last 2 months. The patient had been on immunosuppressive drugs, tacrolimus, prednisolone, and mycophenolic acid since her first renal transplant as well as on cinacalcet after parathyroidectomy (at age 54). Initial computed tomography (CT) scan demonstrated ground-glass opacities in bilateral upper lobes while bronchoscopy revealed few inflammatory cells without any fungi or bacteria. Repeat CT scan performed 5 days later due to rapid progression of her clinical symptoms showed worsening of ground-glass opacities in bilateral upper lobes and new nodules in right middle and lower lung lobes. The wedge lung biopsy revealed metastatic pulmonary calcification (MPC) in the right upper lobe while nonspecific interstitial pneumonia (NISP) in the right lower lobe confirmed the coexistence of two different pathological processes most likely complicating the patient’s clinical symptoms. Despite comprehensive medical therapy, patient’s symptoms have been progressively worsening and she is currently undergoing evaluation for both renal and lung transplants. Our case report not only presents a rare case of MPC coexisting with NSIP but also sheds light on the associated morbidity due to pulmonary diseases in CKD patients.