Hypercalcaemia as a prodromal feature of indolent Pneumocystis jivorecii after renal transplantation

Bency, Rosamma; Roger, Simon D.; Elder, Grahame J.

doi:10.1093/ndt/gfr051

Cited by 17 publications

(14 citation statements)

References 12 publications

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“…The increase in serum calcium was due to granulomatous PCP infection and extrarenal produc tion of 1,25OH2D [35] . Hypercalcemia may be a prodromal feature of indolent PCP infection with full blown pneumonia developing few months later [36] . Hypercalcemia and suppressed PTH level normally resolve after a successful treatment of pneumonia.…”

Section: Calciummentioning

confidence: 99%

Mineral and bone disorder after kidney transplantation

Taweesedt

Disthabanchong

2015

WJT

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After successful kidney transplantation, accumulated waste products and electrolytes are excreted and regulatory hormones return to normal levels. Despite the improvement in mineral metabolites and mineral regulating hormones after kidney transplantation, abnormal bone and mineral metabolism continues to present in most patients. During the first 3 mo, fibroblast growth factor-23 (FGF-23) and parathyroid hormone levels decrease rapidly in association with an increase in 1,25-dihydroxyvitamin D production. Renal phosphate excretion resumes and serum calcium, if elevated before, returns toward normal levels. FGF-23 excess during the first 3-12 mo results in exaggerated renal phosphate loss and hypophosphatemia occurs in some patients. After 1 year, FGF-23 and serum phosphate return to normal levels but persistent hyperparathyroidism remains in some patients. The progression of vascular calcification also attenuates. High dose corticosteroid and persistent hyperparathyroidism are the most important factors influencing abnormal bone and mineral metabolism in long-term kidney transplant (KT) recipients. Bone loss occurs at a highest rate during the first 6-12 mo after transplantation. Measurement of bone mineral density is recommended in patients with estimated glomerular filtration rate > 30 mL/min. The use of active vitamin D with or without bisphosphonate is effective in preventing early post-transplant bone loss. Steroid withdrawal regimen is also beneficial in preservation of bone mass in long-term. Calcimimetic is an alternative therapy to parathyroidectomy in KT recipients with persistent hyperparathyroidism. If parathyroidectomy is required, subtotal to near total parathyroidectomy is recommended. Performing parathyroidectomy during the waiting period prior to transplantation is also preferred in patients with severe hyperparathyroidism associated with hypercalcemia.

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Section: Calciummentioning

confidence: 99%

Mineral and bone disorder after kidney transplantation

Taweesedt

Disthabanchong

2015

WJT

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“…Since 2002, several additional cases of Pneumocystis ‐induced hypercalcemia have been reported in renal transplant recipients; however, only one of these cases obtained or reported histopathology (Table ) . To our knowledge, our case is only the third to report histopathology in the setting of Pneumocystis ‐induced hypercalcemia in renal transplant recipients, and only the second to document a granulomatous reaction in this setting.…”

Section: Discussionmentioning

confidence: 72%

“…While rare, there have been increasing reports of hypercalcemia presenting in association with Pneumocystis infections in renal transplant recipients since 2002 . Here, we describe a renal transplant recipient, who was found to have hypercalcemia, elevated 1,25(OH) 2 D, and acute kidney injury (AKI) when presenting with mild respiratory symptoms 13 years following renal transplantation.…”

Section: Introductionmentioning

confidence: 94%

A case of Pneumocystis pneumonia, with a granulomatous response and vitamin D‐mediated hypercalcemia, presenting 13 years after renal transplantation

Taylor

Aesif

Matson

2019

Transplant Infectious Dis

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Vitamin D‐mediated hypercalcemia is an uncommon complication of Pneumocystis infection. A granulomatous response resulting from Pneumocystis infection is also atypical. In this report, we describe an exceptional case of granulomatous Pneumocystis pneumonia associated with vitamin D‐mediated hypercalcemia, in a patient who presented unusually late after renal transplantation. The patient's hypercalcemia resolved with treatment of the infection.

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“…10 Recently hypercalcemia in PJP has also been reported in recipients of kidney transplant receiving immunosuppressive therapy. 4,5 …”

Section: Discussionmentioning

confidence: 99%

“…1,2 Few patients with Pneumocystis infection develop hypercalcemia caused by elevated 1,25(OH) 2 -vitamin D (1,25(OH) 2 -D). 3-5 The latter is due to the fact that in chronic granulomatous conditions activated macrophages produce 1,25(OH) 2 -D dependent on the substrate, 25(OH)-vitamin D (25(OH)-D) availability, but is not regulated by feedback from calcium, parathyroid hormone (PTH), or 1,25(OH) 2 -D. 6-9 …”

Section: Introductionmentioning

confidence: 99%

Life-Threatening Hypercalcemia During Prodrome of Pneumocystis jiroveci Pneumonia in an Immunocompetent Infant

VanSickle

Srivastava

Alon

2017

Global Pediatric Health

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Severe hypercalcemia in infants is usually attributed to genetic etiologies and less commonly to acquired ones. An 8-week-old girl presented with failure to thrive, mild respiratory distress, and life-threatening hypercalcemia (23.5 mg/dL). Serum 1,25(OH)2-vitamin D (1,25(OH)2-D) level was elevated and parathyroid hormone undetectable. Evaluation for genetic mutations and malignant etiologies of hypercalcemia was negative. Treatment with intravenous hydration, loop diuretic, and calcitonin failed to correct the hypercalcemia, which was subsequently controlled with bisphosphonate therapy. Due to progressive respiratory deterioration, a bronchopulmonary lavage was done on day 17 of her hospitalization disclosing Pneumocystis jiroveci infection. The subsequent immunological investigation showed no abnormalities. She was treated with trimethoprim/sulfamethoxazole resulting in gradual clearing of her lungs and normalization of serum 1,25(OH)2-D level. A year later, she remains healthy with normal biochemical parameters of mineral metabolism. We conclude that in a child with hypercalcemia with suppressed parathyroid hormone and elevated 1,25(OH)2-D, once the genetic etiology for elevated 1,25(OH)2-D and malignancy are ruled out, one should investigate closely for a chronic granulomatous disease. Among the latter Pneumocystis jiroveci pneumonia infection should be considered even in an immunocompetent child.

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Hypercalcaemia as a prodromal feature of indolent Pneumocystis jivorecii after renal transplantation

Cited by 17 publications

References 12 publications

Mineral and bone disorder after kidney transplantation

Mineral and bone disorder after kidney transplantation

A case of Pneumocystis pneumonia, with a granulomatous response and vitamin D‐mediated hypercalcemia, presenting 13 years after renal transplantation

Life-Threatening Hypercalcemia During Prodrome of Pneumocystis jiroveci Pneumonia in an Immunocompetent Infant

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