홍덕호

418

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￭

Severe pneumonia and hypocalcemia following a single injection of denosumab in a patient with asthma

1명지병원 내과, ²명지병원 내분비내과

*

홍덕호

, 이민경

, 이재혁

, 손서영

Introduction: Denosumab is a RANKL inhibitor, which is used for the treatment of osteoporosis, bone pain, and bone metastasis. This case report de- scribes a patient with asthma who developed severe pneumonia and hypocalcemia after receiving denosumab. The Case: We report on a 78-year old fe- male with hypertension, type 2 diabetes, asthma, and dementia. She injected single dose of denosumab for her osteoporosis at other hospital 2 weeks before her visit. She was initially admitted with dyspnea, her chest CT reported pneumonia with atelectasis, and antibiotics were treated for pneumonia. On the day of admission, her corrected calcium level was 4.0 mg/dl, phosphorus was 2.5mg/dl, 25-hydroxyvitamin D was 6.6, and intact PTH was 347.2pg/ml. We treated intravenous calcium gluconate, oral calcium, calcitriol and cholecalciferol, and the patient’s blood calcium returned to near normal (8.3 mg/dL) 3 weeks later. Conclusion: Denosumab is a human monoclonal antibody given subcutaneously, and the side effects of denosumab are increased infection risk, nonspecific dermatologic reactions, and hypocalcemia. This was a rare case that pneumonia and hypocalcemia co-occurred after denosumab injection.

Infection risk and calcium levels should be checked before the start of therapy.

￭

￭

A Case of New-Onset Diabetes Associated with Renal Cell Carcinoma

한국원자력의학원 원자력병원 내과

*

송월화, 김홍일

Background: Patients with renal cell carcinoma (RCC) can experience various paraneoplastic symptoms. However, hyperglycemia as a paraneoplastic syndrome associated with RCC is rare and only a few cases have been reported in foreign countries. Although the cause of severe hyperglycemia has not been elucidated, several mechanisms have been suggested, including ectopic production of glucagon, increased levels of autoimmune antibodies, and inter- leukin-6-mediated pathways. Here, we present a case of new-onset diabetes associated with RCC, which has not been previously reported in Korea.

Case: A 55-year-old man visited our emergency room for bilateral lower extremity weakness. He had lost 5 kg body weight in a week and presented with polydipsia, polyuria, and polyphagia. His height and maximum weight were 176 cm and 78 kg, respectively, and he had no family history of diabetes. There was no diabetic retinopathy on fundus examination. His serum glucose concentration was 669 mg/dL, and HbA1c level was 10.9%. Serum osmolality was 302 mOsm/kgH2O. There was no acidosis on blood gas analysis. Abdominal computed tomography was performed, which revealed a heterogeneously en- hancing mass, about 7.3 × 5.5 cm in size, in the lower pole of the left kidney, suggesting RCC. He was hospitalized and required up to 60 IU/day of insulin preoperatively. He underwent left radical nephrectomy, and pathology revealed clear cell-type RCC. Insulin therapy was discontinued several days after surgery as the patient developed hypoglycemia. He was discharged after conversion to oral diabetic medication. Nine months after discharge, oral anti-dia- betic medication was stopped as his HbA1c level decreased to 6.0%. Three months later, there was no deterioration of glycemic control. Conclusion: In this patient, new-onset diabetes is likely to be attributed to RCC as it remitted without medication following nephrectomy. This report highlights severe, acute hyperglycemia in a patient with a renal mass on imaging, who had a low risk of diabetes, as a rare paraneoplastic syndrome associated with RCC.

418

￭

￭

Severe pneumonia and hypocalcemia following a single injection of denosumab in a patient with asthma

1명지병원 내과, ²명지병원 내분비내과

*

홍덕호

, 이민경

, 이재혁

, 손서영

Introduction: Denosumab is a RANKL inhibitor, which is used for the treatment of osteoporosis, bone pain, and bone metastasis. This case report de- scribes a patient with asthma who developed severe pneumonia and hypocalcemia after receiving denosumab. The Case: We report on a 78-year old fe- male with hypertension, type 2 diabetes, asthma, and dementia. She injected single dose of denosumab for her osteoporosis at other hospital 2 weeks before her visit. She was initially admitted with dyspnea, her chest CT reported pneumonia with atelectasis, and antibiotics were treated for pneumonia. On the day of admission, her corrected calcium level was 4.0 mg/dl, phosphorus was 2.5mg/dl, 25-hydroxyvitamin D was 6.6, and intact PTH was 347.2pg/ml. We treated intravenous calcium gluconate, oral calcium, calcitriol and cholecalciferol, and the patient’s blood calcium returned to near normal (8.3 mg/dL) 3 weeks later. Conclusion: Denosumab is a human monoclonal antibody given subcutaneously, and the side effects of denosumab are increased infection risk, nonspecific dermatologic reactions, and hypocalcemia. This was a rare case that pneumonia and hypocalcemia co-occurred after denosumab injection.

Infection risk and calcium levels should be checked before the start of therapy.

￭

￭

A Case of New-Onset Diabetes Associated with Renal Cell Carcinoma

한국원자력의학원 원자력병원 내과

*

송월화, 김홍일

Background: Patients with renal cell carcinoma (RCC) can experience various paraneoplastic symptoms. However, hyperglycemia as a paraneoplastic syndrome associated with RCC is rare and only a few cases have been reported in foreign countries. Although the cause of severe hyperglycemia has not been elucidated, several mechanisms have been suggested, including ectopic production of glucagon, increased levels of autoimmune antibodies, and inter- leukin-6-mediated pathways. Here, we present a case of new-onset diabetes associated with RCC, which has not been previously reported in Korea.

Case: A 55-year-old man visited our emergency room for bilateral lower extremity weakness. He had lost 5 kg body weight in a week and presented with polydipsia, polyuria, and polyphagia. His height and maximum weight were 176 cm and 78 kg, respectively, and he had no family history of diabetes. There was no diabetic retinopathy on fundus examination. His serum glucose concentration was 669 mg/dL, and HbA1c level was 10.9%. Serum osmolality was 302 mOsm/kgH2O. There was no acidosis on blood gas analysis. Abdominal computed tomography was performed, which revealed a heterogeneously en- hancing mass, about 7.3 × 5.5 cm in size, in the lower pole of the left kidney, suggesting RCC. He was hospitalized and required up to 60 IU/day of insulin preoperatively. He underwent left radical nephrectomy, and pathology revealed clear cell-type RCC. Insulin therapy was discontinued several days after surgery as the patient developed hypoglycemia. He was discharged after conversion to oral diabetic medication. Nine months after discharge, oral anti-dia- betic medication was stopped as his HbA1c level decreased to 6.0%. Three months later, there was no deterioration of glycemic control. Conclusion: In this patient, new-onset diabetes is likely to be attributed to RCC as it remitted without medication following nephrectomy. This report highlights severe, acute hyperglycemia in a patient with a renal mass on imaging, who had a low risk of diabetes, as a rare paraneoplastic syndrome associated with RCC.