Abstract: SA-PO525
A Modern and Hip Cause of Profound Hypercalcemia
Session Information
- Acid-Base, Calcium, Potassium, and Magnesium Disorders: Clinical
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Alsaleh, Saud Abdulelah, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Stevens, Trevor C., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Fissell, William Henry, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Introduction
Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA) is triggered by adjuvants causing abnormal immune responses. Though usually linked to vaccines and medical products, its link to arthroplasty and cement leak is unexplored. We describe a hypercalcemia case due to ASIA after left hip arthroplasty.
Case Description
A 69-year-old woman with chronic kidney disease had a left hip replacement complicated by dislocation. During revision, there was cement leak into her intramedullary canal. Post-operatively, she developed intermittent episodes of hypercalcemia, which progressed to hypercalcemia (14.7 mg/dL) four years later. Work-up in (see table) was suggestive of granulomatous disease. A PET scan showed intense uptake around the hip arthroplasty and iliac adenopathy, soft tissue biopsy was unrevealing. Therapy with steroids improved her condition along with Vit D 1,25 level, tapering led to return of hypercalcemia and chorioretinitis. Symptoms and response to steroids suggested ASIA with a sarcoid-like reaction.
Discussion
The cement leak from arthroplasty exposes individuals to components, potentially acting as adjuvants and triggering ASIA-like symptoms. ASIA is linked to manifestations such as granulomas, hypercalcemia, uveitis, and CKD. The temporal relationship in this case between cement leak and the onset of autoimmune symptoms suggests ASIA as a potential complication of arthroplasty. More research is needed to establish diagnostic criteria and treatment for ASIA.
| Test | Result | Test | Result |
| PTH | 14 pmol/L | Free light chain | Normal ratio |
| 25 Vitamin D | 23 pg/mL | Serum Histoplasmosis | Negative |
| 1, 25 OH Vitamin D | 150 pg/mL | Serum Blastomycosis | Negative |
| PTHrp | 8 pmol/L | Immunoglobulins | Normal levels |
| ACE | 95 U/L | IGRA | Negative |
| SPEP/UPEP | No monoclonal disease | HIV | Negative |