Calcitriol-mediated hypercalcaemia and increased interleukins in a patientwith sarcoid myopathy

In this report we describe a patient with Sjogren's syndrome (SS) and calci triol-mediated hypercalcaemia. Initially, there was no clinical evidence of sarcoidosis. The patient had hypercalcaemia associated with increased calc itriol serum levels; circulating interleukin-6 and tumour necrosis factor a lpha levels were also elevated. At the beginning, therapy with clodronate w as effective in decreasing the serum calcium levels. However, the serum cal citriol decreased only after chloroquine treatment was added. After 2 years of therapy, the patient developed progressive and extensive muscle weaknes s. A muscle biopsy revealed a very prominent non-caseating granulomatous my opathy. Corticosteroid therapy was then instituted. Although both chloroqui ne and corticosteroid therapy were associated with decreased serum interleu kin and calcitriol levels, only corticosteroid therapy was effective in tre ating the sarcoid myopathy. The role of cytokines in calcitriol mediated hy percalcaemia is discussed.