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Hypercalcemia Heralding Pneumocystis jirovecii Pneumonia in an HIV-Seronegative Patient with Diffuse Cutaneous

Quentin Binet1, Jacques Mairesse2, Marie Vanthuyne3,4

  • 1Division of General Internal Medicine and Infectiology, Clinique St-Pierre Ottignies, Avenue Reine Fabiola, 9, 1340, Ottignies, Belgium. quentin.binet@uclouvain.be.

Mycopathologia
|November 16, 2019
PubMed

Insights

Pneumocystis pneumonia (PCP), a fungal infection, can occur in immunocompromised patients. This case highlights PCP in a systemic sclerosis patient with unusual hypercalcemia, emphasizing early diagnosis for effective treatment.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Rheumatology

Background:

  • Pneumocystis pneumonia (PCP) is a severe opportunistic infection common in immunocompromised individuals.
  • Systemic sclerosis is an autoimmune disease that can lead to various complications.
  • Hypercalcemia, particularly with altered vitamin D levels, can be a complex metabolic issue.

Observation:

  • A 59-year-old male with severe diffuse cutaneous systemic sclerosis presented with respiratory symptoms and asthenia.
  • Laboratory findings revealed severe hypercalcemia, low 25-hydroxyvitamin D, and elevated 1,25-dihydroxyvitamin D, independent of parathyroid hormone.
  • Early diagnosis of PCP was achieved through bronchoalveolar lavage.

Findings:

  • The patient was diagnosed with Pneumocystis pneumonia (PCP).
  • The case presented with a unique pattern of hypercalcemia and vitamin D dysregulation.
  • Prompt diagnosis facilitated targeted antifungal treatment.

Implications:

  • This case underscores the importance of considering PCP in immunocompromised patients, even with atypical presentations.
  • Understanding the interplay between systemic sclerosis, hypercalcemia, and PCP is crucial for patient management.
  • Early diagnostic interventions like bronchoalveolar lavage are vital for timely and effective treatment of PCP.
Keywords:
HypercalcemiaImmunocompromisedPneumocystis pneumoniaSystemic sclerosis

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