Hypercalcemia associated with mineral oil-induced sclerosing paraffinomas

Endocr Pract. 2013 Mar-Apr;19(2):e50-6. doi: 10.4158/EP12092.CR.

Abstract

Objective: Granuloma-forming diseases such as sarcoidosis are associated with extrarenal synthesis of 1,25-dihydroxyvitamin D [1,25(OH)₂D]. We describe a case of extensive skin lesions associated with mineral oil injections in which we provide evidence for cutaneous granuloma synthesis of 1,25(OH)₂D in the pathogenesis of the patient's hypercalcemia.

Methods: Analysis of expression of the 25(OH)D-1a-hydroxylase (1-a OHase [CYP27b1]) was carried out by immunohistochemical analysis of involved skin.

Results: In involved skin, expression of CYP27b1 was found in the dermis, where it is not normally expressed. Successful management of hypercalcemia was achieved with glucocorticoids.

Conclusions: Hypercalcemia associated with mineral oil induced skin lesions is likely driven by unregulated expression of CYP27b1 by inflammatory monocytes and macrophages infiltrating the dermis.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 25-Hydroxyvitamin D3 1-alpha-Hydroxylase / metabolism
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Cellulitis / chemically induced
  • Cellulitis / surgery
  • Cosmetic Techniques / adverse effects
  • Glucocorticoids / therapeutic use
  • Granuloma / drug therapy
  • Granuloma / immunology
  • Granuloma / pathology
  • Granuloma / physiopathology*
  • Humans
  • Hypercalcemia / etiology*
  • Hypercalcemia / prevention & control
  • Injections, Subcutaneous
  • Lower Extremity
  • Macrophages / drug effects
  • Macrophages / enzymology
  • Macrophages / immunology*
  • Male
  • Middle Aged
  • Mineral Oil / administration & dosage
  • Mineral Oil / adverse effects
  • Monocytes / drug effects
  • Monocytes / enzymology
  • Monocytes / immunology*
  • Postoperative Complications / drug therapy
  • Postoperative Complications / immunology
  • Postoperative Complications / physiopathology*
  • Prednisone / therapeutic use
  • Sclerosis
  • Skin / drug effects
  • Skin / enzymology
  • Skin / immunology*
  • Skin / pathology
  • Skin Neoplasms / drug therapy
  • Skin Neoplasms / immunology
  • Skin Neoplasms / pathology
  • Skin Neoplasms / physiopathology*
  • Skin Transplantation / adverse effects
  • Skin Transplantation / immunology
  • Treatment Outcome

Substances

  • Antineoplastic Agents, Hormonal
  • Glucocorticoids
  • Mineral Oil
  • 25-Hydroxyvitamin D3 1-alpha-Hydroxylase
  • Prednisone