Methotrexate Treatment for Sarcoidosis-Induced Hypercalcemia

ABSTRACT Objective To present a patient with sarcoidosis-induced hypercalcemia who responded to methotrexate (MTX). Methods The described case includes clinical and biochemical reports. Results A 65-year-old woman presented with bilateral hilar lymphadenopathy and pulmonary nodules. Her calcium and phosphorous levels were 11.4 mg/dL and 3.5 mg/dL, respectively. Blood levels of 25-hydroxyvitamin D and parathyroid hormone were 68 nmol/L and 23 pg/dL, respectively. A diagnosis of sarcoidosis was confirmed by a lymph node biopsy that revealed non-caseating granulomas. Prednisone therapy was efficacious in normalizing the calcium level. However, hypercalcemia recurred when the prednisone dosage was tapered to below15 mg daily. Following initiation of MTX at 15 mg/week, prednisone levels were successfully titrated to 3 mg daily. After a temporary withdrawal of MTX therapy, calcium levels increased dramatically to 17 mg/dL. Conclusion MTX can be used as treatment for sarcoidosis-induced hypercalcemia. Abbreviations MTX methotrexate PTH parathyroid hormone TNF tumor necrosis factor