Diffuse pulmonary calcification syndrome - a case report

Abstract

Diffuse pulmonary calcification can be (1) metastatic, in which the calcium deposits occur in normal tissues, or (2) dystrophic, in which calcification occurs on injured lung tissue. The pathogenesis of these abnormalities is not fully understood, but hypercalcemia, hyperphosphatemia, alkalosis, and lung damage predispose to calcification and ossification. Standard digital radiography and high resolution computed tomography (HRCT) offer excellent diagnostic sensitivity in the detection of small calcifications inside the lung. We describe the case of a 35 year old male admitted with acute respiratory failure due to acute on chronic lung pathology. His blood culture and bronchial wash cultures were sterile throughout the illness. Bronchial wash culture was negative for acid fast bacilli (AFB), on Gram staining and for any fungal growth. Smears were negative for malignancy. CT scan of the chest showed multiple nodules bilaterally. As all the cultures were sterile, in view of history of unexplained fever, weight loss and unexplained finding of pulmonary nodular lesions, the patient was further investigated on the lines of vasculitic syndromes and the possibility of these syndromes was also ruled out. Postmortem biopsy revealed a diagnosis of diffuse pulmonary calcification syndrome. Diffuse pulmonary calcification is a progressive, normally asymptomatic disease but can lead to critical and fulminant respiratory failure.