CHEST Guidelines-A-71-Year-Old-Man-With-Dyspnea-and-Cough-During-Ch

A-71-Year-Old-Man-With-Dyspnea-and-Cough-During-Ch

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A 71-year-old Japanese man with a history of multiple myeloma presented with worsening dyspnea and cough during chemotherapy for relapsed disease. Previously, he had undergone thyroid and parathyroid surgery for carcinoma and exhibited severe hypercalcemia during treatment with lenalidomide and dexamethasone. Following treatment for a urinary tract infection and hypercalcemia, he continued to experience respiratory distress, marked by bilateral lung opacities on chest radiographs and enlarged cardiac contour. A CT scan showed dense lung consolidations and small pleural effusions, leading to a referral for further investigation.<br /><br />Upon examination, the patient exhibited respiratory distress with signs including bilateral lung crackles, jugular vein distention, and wheezing. Despite normal cardiac function and the absence of significant neurologic or peripheral edema, imaging revealed notable high-attenuated lung consolidation and myocardial calcifications. A bronchoscopy showed multiple small nodular lesions, and biopsy results indicated fine calcific substances in the lungs.<br /><br />The patient was diagnosed with metastatic pulmonary calcification (MPC), characterized by calcium salt deposits in the lungs under conditions of elevated calcium-phosphate product levels. MPC can result from excessive osteolysis in multiple myeloma cases. Treatment with alfacalcidol and ferric citrate hydrate improved his hypoxemia and resolved lung opacities, suggesting amelioration of calcium imbalances.<br /><br />MPC often presents with minimal clinical signs but can lead to acute lung injury, especially in myeloma patients. Management typically involves correcting biochemical abnormalities and addressing the underlying cause of calcium elevation. In this case, normalization of calcium and phosphorus levels was crucial, highlighting the reversibility of MPC-related lung changes when effectively treated.

Keywords

metastatic pulmonary calcification

multiple myeloma

hypercalcemia

lung opacities

calcium-phosphate product

osteolysis

alfacalcidol

ferric citrate hydrate

respiratory distress

lung consolidations