Rapid onset metastatic pulmonary calcifications in end-stage renal disease

Abstract

Metastatic calcifi cation occurs in patients on long-term dialysis. Electrolyte imbalances in these individuals can result in calcium deposition into otherwise normal tissues. In this article, we present the unusual case of a patient who progressed to end-stage renal disease soon after a liver transplant and developed extensive pulmonary metastatic calcifi cations within a few months of starting dialysis. A 56-year-old female underwent an orthotopic liver transplant for end-stage liver disease secondary to hepatitis C; her immunosuppression included tacrolimus and prednisone. She developed acute kidney injury in the immediate post-operative period, which progressed to end-stage renal disease. Her serum calcium and phosphorus levels were within normal limits. Within a few months, a CT scan of her chest showed progressive development of metastatic pulmonary calcifi cation. A CTguided right lung biopsy showed extensive calcifi cation in the alveolar and blood vessel walls with fi broblastic plugs in the alveolar spaces. To our knowledge, this is the fi rst report of metastatic pulmonary calcifi cation developing rapidly after initiation of hemodialysis. Immunosuppressive therapy may have played a role in the development of metastatic calcifi cation.