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Hypercalcemia associated with infection by Cryptococcus neoformans and Coccidioides immitis
M Y Ali1, K V Gopal, L A Llerena
1Division of Infectious Disease and Endocrinology, Fairview General Hospital, Cleveland Clinic Health System, Ohio, USA.
The American Journal of the Medical Sciences
|January 1, 2000
Summary
Hypercalcemia in patients with HIV and fungal infections may be caused by elevated 1,25-dihydroxyvitamin D. Treatment of the fungal infection resolved hypercalcemia, suggesting a link between vitamin D levels and fungal disease.
Area of Science:
- Endocrinology
- Infectious Diseases
- Nephrology
Background:
- Hypercalcemia is rare in fungal infections, with only 13 cases reported.
- Previous cases linked hypercalcemia to Cryptococcus neoformans and Coccidioides immitis.
- This study reports a patient with HIV, C. immitis and C. neoformans pneumonia, and C. immitis fungemia experiencing hypercalcemia.
Observation:
- The patient presented with hypercalcemia, undetectable parathyroid hormone (PTH) and parathyroid hormone-related protein (PTHrp).
- Serum 25-hydroxyvitamin D levels were normal, while 1,25-dihydroxyvitamin D levels were high-normal.
- Successful treatment of fungal infections led to hypercalcemia resolution and normalization of PTH and PTHrp.
Findings:
- Elevated 1,25-dihydroxyvitamin D may be responsible for hypercalcemia in some HIV patients with severe fungal infections.
- Serum 1,25-dihydroxyvitamin D levels can be inappropriately high for the clinical context, even if not frankly elevated.
- Free 1,25-dihydroxyvitamin D levels are crucial for accurate assessment in such cases.
Implications:
- This finding suggests a potential mechanism for hypercalcemia in immunocompromised patients with fungal infections.
- Monitoring 1,25-dihydroxyvitamin D levels may be important for managing hypercalcemia in this patient population.
- Further research is warranted to elucidate the precise relationship between fungal infections, vitamin D metabolism, and hypercalcemia.