Refractory hypercalcaemia associated with disseminated Cryptococcus neoformans infection.

Area of Science:

• Endocrinology
• Infectious Diseases
• Nephrology

Background:

• Hypercalcaemia is a common endocrine disorder.
• Severe hypercalcaemia due to fungal infections is exceptionally rare, with limited literature.
• Cryptococcus infection is an infrequent cause of hypercalcaemia.

Purpose of the Study:

• To report a case of refractory hypercalcaemia in a patient with Cryptococcus neoformans infection.
• To discuss the potential mechanisms and management of fungal infection-associated hypercalcaemia.

Main Methods:

• Case report of a 55-year-old woman.
• Literature review on hypercalcaemia associated with fungal infections.
• Detailed description of the patient's treatment regimen.

Main Results:

• The patient presented with refractory 1,25-dihydroxyvitamin D-mediated hypercalcaemia.
• Treatment involved antifungals, pamidronate, calcitonin, denosumab, and high-dose glucocorticoids.
• The patient's hypercalcaemia was linked to a Cryptococcus neoformans infection.

Conclusions:

• Disseminated fungal infections should be suspected in immunosuppressed individuals with hypercalcaemia.
• Glucocorticoids can treat 1,25-dihydroxyvitamin D-driven hypercalcaemia but require careful risk-benefit assessment.
• Fluconazole may effectively treat both the hypercalcaemia and the fungal infection.