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Hypercalcemia Due to Progressive Disseminated Histoplasmosis
Lakshmipriya Thandiyekkal Rajan1, Naman Aggarwal1, Jayakrishnan C Menon1
1Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India.
Insights
Progressive disseminated histoplasmosis is a rare cause of severe hypercalcemia. Prompt diagnosis and treatment with antifungal medications can effectively manage this life-threatening condition.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Endocrinology
Background:
- Hypercalcemia presents a common yet diagnostically challenging clinical issue.
- Identifying the underlying etiology of hypercalcemia is crucial for effective and potentially life-saving treatment.
Observation:
- A 61-year-old male presented with constitutional symptoms and altered sensorium, revealing severe hypercalcemia.
- Laboratory results indicated parathyroid hormone-independent hypercalcemia with elevated 1,25-dihydroxyvitamin D levels, suggesting a granulomatous etiology.
- Radiological findings showed a multisystem disorder including adrenal enlargement, lymphadenopathy, and hepatosplenomegaly.
Findings:
- Diagnosis of progressive disseminated histoplasmosis was confirmed via adrenal gland and bone marrow biopsy.
- Treatment involved liposomal amphotericin B followed by itraconazole, leading to serum calcium normalization and symptom resolution.
- This case highlights histoplasmosis as an infrequent cause of hypercalcemia, with fewer than 22 reported instances globally.
Implications:
- This case underscores the importance of considering rare infectious etiologies in the workup of hypercalcemia.
- Effective antifungal therapy can successfully resolve hypercalcemia and associated symptoms in histoplasmosis.
- Raising awareness of histoplasmosis as a cause of hypercalcemia can improve diagnostic timeliness and patient outcomes.
Abstract:
Hypercalcemia is a relatively common clinical problem, and evaluation for its etiology may often prove to be challenging. However, a thorough etiological workup can guide effective therapy and can often prove to be lifesaving. We describe a 61-year-old man who presented with fever, anorexia, and weight loss for 3 months, and altered sensorium for around 1 week. His evaluation revealed severe hypercalcemia, correction of which led to improvement in his symptoms. Workup for the cause revealed that he had parathyroid hormone-independent hypercalcemia with elevated levels of 1,25-dihydroxyvitamin D, suggesting a granulomatous disease. Radiological evaluation was suggestive of a multisystem disorder with bilateral adrenal enlargement, generalized lymphadenopathy, and hepatosplenomegaly. Biopsy from the adrenal gland and bone marrow clinched the diagnosis of progressive disseminated histoplasmosis, which required treatment with liposomal amphotericin B for a total duration of 4 weeks, followed by oral itraconazole. The effective treatment was associated with normalization of serum calcium and disappearance of symptoms. Histoplasmosis represents a rare cause of hypercalcemia, with only around 22 such cases having been reported worldwide.
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