Myositis, rhabdomyolysis and severe hypercalcaemia in a body builder

[摘要] A 53-year-old man who used growth hormone (GH), anabolic steroids and testosterone (T) for over 20 years presentedwith severe constipation and hypercalcaemia. He had benign prostatic hyperplasia and renal stones but no significantfamily history. Investigations showed – (1) corrected calcium (reference range) 3.66 mmol/L (2.2–2.6), phosphate1.39 mmol/L (0.80–1.50), and PTH 2 pmol/L (1.6–7.2); (2) urea 21.9 mmol/L (2.5–7.8), creatinine 319 mmol/L (58–110),eGFR 18 mL/min (>90), and urine analysis (protein 4+, glucose 4+, red cells 2+); (3) creatine kinase 7952 U/L (40–320),positive anti Jo-1, and Ro-52 antibodies; (4) vitamin D 46 nmol/L (30–50), vitamin D3 29 pmol/L (55–139), vitamin A4.65 mmol/L (1.10–2.60), and normal protein electrophoresis; (5) normal CT thorax, abdomen and pelvis and MRI ofmuscles showed ‘inflammation’, myositis and calcification; (6) biopsy of thigh muscles showed active myositis, chronicmyopathic changes and mineral deposition and of the kidneys showed positive CD3 and CD45, focal segmentalglomerulosclerosis and hypercalcaemic tubular changes; and (7) echocardiography showed left ventricular hypertrophy(likely medications and myositis contributing), aortic stenosis and an ejection fraction of 44%, and MRI confirmed thesewith possible right coronary artery disease. Hypercalcaemia was possibly multifactorial – (1) calcium release followingmyositis, rhabdomyolysis and acute kidney injury; (2) possible primary hyperparathyroidism (a low but detectable PTH);and (3) hypervitaminosis A. He was hydrated and given pamidronate, mycophenolate and prednisolone. Followinginitial biochemical and clinical improvement, he had multiple subsequent admissions for hypercalcaemia and renaldeterioration. He continued taking GH and T despite counselling but died suddenly of a myocardial infarction.

[学科分类] 血液学