Hypercalcemia Associated with Infection by Cryptococcus neoformans and Coccidioides immitis

Ali, M Y; Gopal, K.; Llerena, L.A.; Taylor, Harris C.

doi:10.1097/00000441-199912000-00010

Cited by 41 publications

(28 citation statements)

References 29 publications

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“…Sarcoidosis is the human disease most commonly complicated by endogenous vitamin D intoxication [47,49,269] Leprosy [54,55,270] Candidiasis [36] Cryptococcosis [56,271,272] Histoplasmosis [273] Coccidiodomycosis [58] AIDS-related pneumocystis [59] Cat-scratch fever [274])…”

Section: Sarcoidosismentioning

confidence: 99%

Extrarenal 1α-Hydroxylase

Hewison¹,

Adams²

2011

Vitamin D

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Section: Sarcoidosismentioning

confidence: 99%

Extrarenal 1α-Hydroxylase

Hewison¹,

Adams²

2011

Vitamin D

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“…A detecção da elevação e normalização da relação α1 microglobulina/creatinina urinária reforça que o efeito da lesão tubular tenha sido transitório e reversível. Na literatura, há relatos de hipercalcemia associada a doenças granulomatosas, como a produzida pela tuberculose 9 , sarcoidose 10 , histoplasmose 11 e criptococose 20 , sendo encontrado apenas um caso descrito em PCM 12 . Não há, nesses relatos, associação com lesões osteolíti-cas, sendo a hipercalcemia pouco esclarecida.…”

Section: Figura 2 -Detalhes De Radiografias Do Ombro Direitounclassified

Hypercalcemia and multiple osteolytic lesions in a child with disseminated paracoccidioidomycosis and pulmonary tuberculosis

Tresoldi¹,

Pereira²,

Castro³

et al. 2005

J Pediatr (Rio J)

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Objective: To describe the case of a child with paracoccidioidomycosis who presented hypercalcemia with multiple osteolytic lesions.Description: A 6-year-old boy was admitted with a one-month history of fever and hepatosplenomegaly. On admission, he looked sick, pale, and had disseminated lymphadenopathy and hepatosplenomegaly. The laboratory findings included anemia (hemoglobin = 6.8 g/dl), eosinophilia (1,222/mm 3 ), thrombocytopenia (102,000/mm 3 ), and hypoalbuminemia (serum albumin = 2.2 g/dl). Paracoccidioides brasiliensis was identified in bone marrow examination. In the second week after admission, the patient presented joint pain, poor activity and difficulty in walking. He presented hypercalcemia (maximum value = 14.9 mg%) and reduction in renal function, which lasted for two weeks. On the 42nd day after admission, his chest X-ray showed lytic lesions in clavicle, scapula, ribs, and humerus, with bilateral slipped capital humeral epiphysis. The patient presented nephrocalcinosis and nephrolithiasis, reduction in creatinine clearance and evidence of tubular lesions. At the end of the second month after admission, Mycobacterium tuberculosis was isolated in gastric lavage. The child received treatment for paracoccidioidomycosis and tuberculosis and has not had any sequelae for 3 years.Comments: The development of symptomatic hypercalcemia leading to renal lesion, associated with multiple osteolytic lesions, had never been described in paracoccidioidomycosis. Although pulmonary tuberculosis was diagnosed and could be related to hypercalcemia, the sudden onset of hypercalcemia and its normalization without specific treatment for tuberculosis suggests that bone lysis was the most important factor in the genesis of hypercalcemia. Descrição: Menino de 6 anos, internado com história de febre e hepatoesplenomegalia há 1 mês. À internação, apresentava-se em regular estado geral, descorado, com linfonodomegalia generalizada e hepatoesplenomegalia. Os exames laboratoriais identificaram anemia (hemoglobina = 6,8 g/dl), eosinofilia (1.222/mm 3 ), plaquetopenia (102.000/mm 3 ) e hipoalbuminemia (albumina = 2,2 g/dl). Paracoccidioides brasiliensis foi identificado no mielograma. A partir da segunda semana de internação, apresentou artralgia, hipoatividade e dificuldade à deambulação, sendo constatada hipercalcemia (dosagem máxima de 14,9 mg%) e redução da função renal, que duraram pouco mais de 2 semanas. No 42° dia de internação, foram vistas, na radiografia de tórax, múltiplas lesões líticas em clavículas, escápulas, costelas e úmeros, com escorregamento epifisário de úmero bilateral. Apresentou nefrocalcinose e nefrolitíase, com redução no clearance de creatinina e evidências de lesão tubular. No final do segundo mês de internação, na cultura do lavado gástrico, foi identificado Mycobacterium tuberculosis. Recebeu tratamento para paracoccidioidomicose e tuberculose e está há mais de 3 anos em acompanhamento, sem nenhuma seqüela.Comentários: O desenvolvimento da hipercalcemia sintomática, levando à lesão rena...

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“…Initial presentation as hypercalcemia and altered mental status is infrequently reported, even in HIV-positive or immunocompromised patients. To our best knowledge, only 3 cases were reported to have hypercalcemia associated with cryptococcosis; two cases with HIV infection were reported by Spindel et al (3) and Ali et al (4) and another one with end-stage renal disease was reported by Wang et al (5). The present case is the first case in an HIV-uninfected and non-uremic patient.…”

Section: Discussionmentioning

confidence: 57%

Vitamin D-Mediated Hypercalcemia as the Initial Manifestation of Pulmonary Cryptococcosis in an HIV-uninfected Patient

et al. 2012

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Hypercalcemia has been described in variety of granulomatous diseases and fungal infections. However, hypercalcemia in pulmonary cryptococcosis is rarely disclosed. We report a 57-year-old HIV-uninfected woman with diabetes, who initially presented with altered mental status, severe hypercalcemia with increased serum 1,25-dihydroxyvitamin D [1,25(OH)2D] concentration and suppressed parathyroid hormone. Pulmonary cryptococcosis was diagnosed as the cause of hypercalcemia. Successful treatment resulted in the resolution of hypercalcemia and decrease of the serum 1,25(OH)2D concentration to within the normal range. In summary, although HIV infection is a major risk factor for cryptococcosis, vitamin D-mediated hypercalcemia could be the initial presentation of pulmonary cryptococcosis in HIV-negative patients.

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Hypercalcemia Associated with Infection by Cryptococcus neoformans and Coccidioides immitis

Cited by 41 publications

References 29 publications

Extrarenal 1α-Hydroxylase

Extrarenal 1α-Hydroxylase

Hypercalcemia and multiple osteolytic lesions in a child with disseminated paracoccidioidomycosis and pulmonary tuberculosis

Vitamin D-Mediated Hypercalcemia as the Initial Manifestation of Pulmonary Cryptococcosis in an HIV-uninfected Patient

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