ABSTRACT
Vitamin D deficiency is a global health issue that afflicts more than one billion children and adults worldwide. Vitamin D supplementation has increased over the years, whether through medical prescriptions, over-the-counter, or online purchasing. This is driven by a more recognized association between vitamin D sufficiency status and lower risk of cancer. In addition, more recently, it is used as a potential prophylactic and treatment for COVID-19 infection. This can lead to toxicity from overingestion. While rare, it has been reported in the literature. In this case report, we present a 75-year-old man with severe hypercalcemia secondary to vitamin D toxicity managed with peritoneal dialysis. He presented with biochemical evidence of hypercalcemia, acute kidney injury, and pancreatitis. Workup for his hypercalcemia led to the diagnosis of vitamin D toxicity as shown by a level greater than 200 ng/dL (Ref: 20-50 ng/mL) was confirmed by liquid chromatography-mass spectroscopy. Cornerstone medical management of hypercalcemia was provided which included aggressive intravenous fluid hydration, intravenous diuretics, calcitonin, bisphosphonate, and corticosteroid therapy. At every interruption of therapy, calcium levels trended upward. A thorough literature review yielded the finding of a sole case report from 1966 presented at the Third International Congress of Nephrology, in which peritoneal dialysis was used in the management of vitamin D toxicity and hypercalcemia. This modality is established to cause vitamin D deficiency. In collaboration with the nephrology team, 10 sessions of peritoneal dialysis were undertaken with resolution of hypercalcemia and downtrend in 25-hydroxyvitamin D levels as measured by dilution.
Subject(s)
Breast/pathology , Calcinosis/diagnosis , Schistosoma/isolation & purification , Schistosomiasis/diagnosis , Aged , Animals , Biopsy , Breast/diagnostic imaging , Breast/parasitology , Breast Neoplasms/diagnosis , Calcinosis/parasitology , Calcinosis/pathology , Diagnosis, Differential , Female , Humans , Image-Guided Biopsy , Mammography , Schistosomiasis/complications , Schistosomiasis/parasitology , Schistosomiasis/pathologySubject(s)
Celiac Disease/immunology , Muscle Weakness/immunology , Osteomalacia/immunology , Rhabdomyolysis/immunology , Adrenal Cortex Hormones/therapeutic use , Celiac Disease/complications , Celiac Disease/diagnosis , Celiac Disease/therapy , Electrolytes/administration & dosage , Female , Fluid Therapy/methods , Humans , Infusions, Intravenous , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/therapy , Myoglobinuria/immunology , Osteomalacia/diagnosis , Osteomalacia/therapy , Rhabdomyolysis/diagnosis , Rhabdomyolysis/therapy , Saline Solution/administration & dosage , Treatment OutcomeABSTRACT
Architectural distortion is the third most-common appearance of breast cancer and often is a subtle finding on mammography. In this article, we review a variety of breast diseases that may present as architectural distortion on mammography; review the utility of correlative imaging, such as ultrasound and magnetic resonance; and review appropriate management for these diagnoses. Primary causes include breast cancer, ductal carcinoma in situ, radial scar, complex sclerosing lesion, and fat necrosis. Secondary etiologies include previous breast surgery, trauma, and infection. Familiarity with imaging findings presenting as distortion on multimodality imaging will optimize detection and management of this subtle-yet-significant finding.
