Hypercalcemia in disseminated histoplasmosis. Aggravation by vitamin D

Hypercalcemia associated with disseminated histoplasmosis in an elderly male is described. Serum calcium levels increased during vitamin D supplementation, supporting the proposed mechanism of hypercalcemia in granulomatous diseases. Rapid clinical deterioration and death occurred shortly after administration of steroids for relative adrenal insufficiency. Vitamin D and calcium supplements may aggravate the hypercalcemia of granulomatous disease and should be avoided.