muramidase and Hypercalcemia

Sarcoidosis is a multisystem granulomatous disease of unknown origin. No single biological marker allows definitive diagnosis of sarcoidosis or may accurately predict the disease prognosis. However, some biological markers are helpful tools as diagnostic aids and disease activity markers. At the blood level, lymphopenia with CD4 depletion, elevated levels of serum-angiotensin converting enzyme, lyzozyme, beta 2 microglobulin and disturbed calcium metabolism resulting in hypercalcemia and hypercalciuria can help guide diagnosis. Lymphocytic alveolitis with a high CD4/CD8 ratio in bronchoalveolar lavage fluid is highly suggestive of the disease. A wide range of new biological markers are proposed but their pronostic significance is still controversial. In clinical practice, biological markers may help in monitoring treated patients with sarcoidisis.

Topics: beta 2-Microglobulin; Biomarkers; CD4 Lymphocyte Count; Humans; Hypercalcemia; Lymphopenia; Muramidase; Peptidyl-Dipeptidase A; Prognosis; Reproducibility of Results; Sarcoidosis; Sensitivity and Specificity

Topics: Amyloidosis; Blood Vessels; Diabetes Insipidus; Humans; Hypercalcemia; Hyponatremia; Kidney; Kidney Diseases; Lactates; Leukemia; Lymphoma; Muramidase; Nephrotic Syndrome; Uric Acid; Urinary Tract

A 53-year-old man was admitted to Osaka City University Hospital on July 21, 1998, for investigation of symptomatic hypercalcemia. Laboratory data on admission revealed that serum Ca had increased to around 12.6 mg/dl and there was a significant increase in urinary Ca excretion. The serum phosphate level remained normal. Although the serum PTH level was below the detection limit, serum 1,25-dihydroxyvitamin D (1,25(OH)2D) was increased. Diagnosis of sarcoidosis was supported by a negative tuberculin test and by the elevated levels of serum angiotensin-converting enzyme (ACE), lysozyme activity, and CD4/CD8 ratio in bronchoalveolar lavage specimen; there was however no imaging evidence of sarcoidosis such as bilateral hilar lymphnode enlargement on chest X-ray, high resolution CT or 67Ga citrate scintigraphy. Biopsy specimens from the cervical lymphnode revealed no epitheloid cell granulomas or giant cells. Administration of prednisolone achieved a decrease in serum ACE and 1,25(OH)2D levels, followed by restoration of serum Ca and urinary Ca excretion to the normal range, and finally by an increase of serum PTH to the normal level. These observations suggested that the hypercalcemia could be explained by extrarenal production of 1,25(OH)2D. We report here on this rare case of sarcoidosis with initial symptoms of symptomatic hypercalcemia resulting from extrarenal production of 1,25(OH)2D.

Topics: Bronchoalveolar Lavage Fluid; Calcitriol; Calcium; CD4-CD8 Ratio; Glucocorticoids; Humans; Hypercalcemia; Male; Middle Aged; Muramidase; Parathyroid Hormone; Peptidyl-Dipeptidase A; Prednisolone; Sarcoidosis; Treatment Outcome

Topics: Calcium; Humans; Hypercalcemia; Leukocytes; Muramidase

Topics: Humans; Hypercalcemia; Leukocytes; Muramidase