1,25-Dihydroxyvitamin D-mediated hypercalcemia in oleogranulomatous mastitis (paraffinoma), ameliorated by glucocorticoid administration

Objective: To report a case of oleogranulomatous mastitis (paraffinoma) in which both the hypercalcemia and the inappropriately elevated 1,25-dihydroxyvitamin D [1,25(OH)2D] levels were successfully reduced by administration of prednisone. Methods: We describe the clinical, imaging, and laboratory findings in the study patient. Furthermore, we review the relevant literature regarding hypercalcemia in oleogranulomatous mastitis. Results: A 58-year-old man with oleogranulomatous mastitis (paraffinoma)-related hypercalcemia, renal failure, and inappropriately elevated levels of 1,25(OH)2D presented to our institution. Treatment with prednisone - 0.5 mg/kg of body weight or 30 mg daily - for 10 days resulted in a reduction of his serum calcium and 1,25(OH)2D levels to near-normal or normal values and a substantial improvement of his renal function. Nevertheless, the patient ultimately died 11 months later of multiple paraffinoma-related complications. Conclusion: In selected cases, treatment with glucocorticoids may offer a temporary relief from paraffinoma-related hypercalcemia until definitive treatment options are feasible.