Hypercalcemia and Acute Kidney Injury Associated with Disseminated Paracoccidioidomycosis

Paracoccidioidomycosis is an acute to chronic systemic mycosis caused by the fungi Paracoccidioides. Hypercalcemia is a rare and not fully understood presentation of this infection. We present a case report of paracoccidioidomycosis associated with hypercalcemia and acute kidney injury (AKI) in an immunocompetent patient. An immunocompetent 30-year-old man from Brazil presented with papular erythematous-violaceous skin lesions, disseminated lymphadenopathy, pain in the left hypochondrium, fever with night sweats, and loss of 25 kilograms in 5 months. The result of a biopsy of the lesions was positive for Paracoccidioides brasiliensis. Laboratory findings were high total calcium and 1,25-dihydroxy vitamin D, with low parathyroid hormone, low albumin, and AKI. Computed tomography scans revealed splenic infarcts without bone lesions. Treatment was performed with methylprednisolone and liposomal amphotericin B. Calcium levels and kidney function normalized within 20 days of hospitalization. The patient was discharged 49 days after admission. A follow-up 6 months later revealed total clinical and serological remission.