Abstract
A-52-year-old patient presented with a 2-year history of multiple myeloma, recurrent episodes of hypercalcemia, and extensive bone involvement. She developed pulmonary infiltrates, initially misdiagnosed as interstitial pneumonia. High-resolution computed tomography and bone scintiscanning indicated pulmonary calcification, which was confirmed by a transbronchial biopsy. Cytostatic treatment of multiple myeloma in combination with repetitive i.v. administration of bis-phosphonates over a period of 6 months led to a significant improvement of clinical symptoms. Regression of pulmonary infiltrates was demonstrated by chest radiograph and computed tomography. There are only a few reports on pulmonary calcification in patients with multiple myeloma; the condition was associated mostly with progressive disease, kidney failure, adult respiratory distress syndrome and bad prognosis. In our patient isolated calcification of the lungs without involvement of other organ systems was successfully treated. These findings suggest that interstitial pulmonary calcinosis in multiple myeloma can be reversed by normalization of serum calcium levels using bisphosphonates combined with cytostatic treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Blind E, Raue F, Götzmann J, Schmidt-Gayk, Kohl B, Ziegler R (1992) Circulating levels of midregional parathyroid hormone-related protein in hypercalcemia of malignancy. Clin Endocrinol 37: 290–297
Conger JD, Hammond WS, Alfrey AC, Contiguglia SR, Stanford RE, Huffer WE (1975) Pulmonary calcification in chronic dialysis patients: clinical and pathological findings. Ann Intern Med 83: 330–336
Durie BGM, Salmon SE (1975) A clinical staging system for multiple myeloma. Cancer 36: 842–854
Fayemi AO, Wisinewski M (1973) Pulmonary calcification in a patient with multiple myeloma. Chest 64: 765–769
Fleisch H, Russell RGG, Bisanz S, Mühlbauer RC, Williams DA (1970) The inhibitory effect of phosphonates on the formation of calcium phosphate crystals in vitro and on aortic and kidney calcification in vivo. Eur J Clin Invest 1: 12–18
Foresti M (1968) A peculiar pattern of massive mortal pulmonary calcinosis during primary hyperparathyreodism. G Clin Med 49: 64–86
Forster J (1993) Multiple myeloma. In: Lee GR, Bithell TC, Forster J, Athens JW, Lukes JN (eds) Wintrobe’s clinical hematology. Lea and Febinger, Philadelphia, pp 2219–2249
Gilman M, Nissim J, Terry P, Whelton A (1980) Metastatic pulmonary calcification in renal transplant recipient. Am Rev Resp Dis 121: 415–421
Kaltreider HB, Baum GL, Bogarty G, McCoy MD, Tucker M (1969) So-called “metastatic” calcification of the lung. Am J Med 46: 188–196
Lahtinen R, Laakso M, Palva I, Virkkunen P, Elomaa I (1992) Randomised, placebo-controlled multicentre trial of clodronate in multiple myeloma. Lancet 340: 1049–1052
Margolin RJ, Addison TE (1984) Hypercalcemia and rapidly progressive respiratory failure. Chest 86: 767–769
Miller S, Vernon-Roberts, McClure J (1984) Cutaneous calciphylactic reactions in the mouse and the rat and the effects of diphosphonates on the reaction in the rat. J Pathol 142: 7–13
Mulligan RM (1947) Metastatic calcification. Arch Pathol 43: 177–230
Neff M, Yalcin S, Gupta S, Berger H (1974) Extensive metastatic calcification of the lung in an azotemic patient. Am J Med 56: 103–106
Poe RH, Chopaldy K, Bauer MA, Qazi R, Kallay MC, Woll JE(1989) Acute respiratory distress syndrome with pulmonary calcification in two patients with B cell malignancies. Respiration 56: 127–133
Rech HM (1986) The effects of etidronate disodium in the prevention of heterotopic ossification following hemiarthroplasty of the hip: continuing studies. Contemp Orthop 13: 31–38
Rohatgi PK (1988) Metastatic pulmonary calcification in sarcoidosis. Respiration 54: 201–203
Rubini ME, Coburn JW, Massry SG, Shinaberger JH (1969) Renal osteodystrophy: some therapeutic considerations relative to long-term dialysis and transplantation. Arch Intern Med 124: 663–669
Sanders C, Frank MS, Rostand SG, Rutsky EA, Barnes GT (1987) Metastatic calcification of the heart and lungs in endstage renal disease: detection and quantification by dual energy digital chest radiography. AJR 149: 881–887
Seymour JF, Gagel RF (1993) Calcitriol: the major humoral mediator of hypercalcemia in Hodgkin’s disease and non-Hodgkins’s lymphomas. Blood 82: 1383–1394
Spencer H (1977) Pathology of the lung. Saunders, Philadelphia, pp 685–688
Van de Casteele M, Verhoef GEG, Demuynck H, Zacheé P, Boogaerts M (1994) Hypercalcemia, monoclonal protein and osteolytic bone lesions in chronic lymphatic leukemia. Ann Hematol 69: 79–80
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Weber, C.K., Friedrich, J.M., Merkle, E. et al. Reversible metastatic pulmonary calcification in a patient with multiple myeloma. Ann Hematol 72, 329–332 (1996). https://doi.org/10.1007/s002770050181
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s002770050181