Severe Hypercalcemia From Inhalation Pneumonitis via Activation of 1,25 Dihydroxyvitamin D

Among the many causes of hypercalcemia are inflammatory conditions, particularly involving granulomatous disease. We present a case of a previously healthy woman who arrived at the emergency department with severe symptomatic hypercalcemia. Workup revealed elevated levels of 1,25-dihydroxyvitamin D along with pneumonitis on computed tomography (CT) imaging. The patient revealed frequent use of eucalyptus oil in her home essential oil diffuser and after removal of the offending agent her hypercalcemia, elevated 1,25-dihydroxyvitamin D, and pneumonitis on CT imaging all resolved.