calcitriol and Cryptococcosis

Hypercalcemia occurs relatively often in dialysis patients. The most common cause of hypercalcemia in dialysis patients is the conventional therapy with calcium and calcitriol. Besides, secondary hyperparathyroidism, low turnover bone diseases, and immobilization are also common causes of hypercalcemia in dialysis patients. Fungal infection associated with hypercalcemia has been infrequently reported. We describe a 71-year-old female woman with end-stage renal disease and diabetes mellitus, who developed severe hypercalcemia. Pulmonary cryptococcosis, with increased concentration of serum 1,25-dihydroxyvitamin D (1,25(OH)2D), was diagnosed. Her serum concentration of calcium and 1,25(OH)2D returned to normal after antifungal treatment. Thus, hypercalcemia was mediated by extrarenal overproduction of 1,25(OH)2D in this patient.

Topics: Aged; Cryptococcosis; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Female; Humans; Hypercalcemia; Kidney Failure, Chronic; Lung Diseases, Fungal; Renal Dialysis; Vitamin D

Hypercalcemia has been described in variety of granulomatous diseases and fungal infections. However, hypercalcemia in pulmonary cryptococcosis is rarely disclosed. We report a 57-year-old HIV-uninfected woman with diabetes, who initially presented with altered mental status, severe hypercalcemia with increased serum 1,25-dihydroxyvitamin D [1,25(OH)₂D] concentration and suppressed parathyroid hormone. Pulmonary cryptococcosis was diagnosed as the cause of hypercalcemia. Successful treatment resulted in the resolution of hypercalcemia and decrease of the serum 1,25(OH₂D concentration to within the normal range. In summary, although HIV infection is a major risk factor for cryptococcosis, vitamin D-mediated hypercalcemia could be the initial presentation of pulmonary cryptococcosis in HIV-negative patients.

Topics: Cryptococcosis; Female; HIV Seronegativity; Humans; Hypercalcemia; Lung Diseases, Fungal; Middle Aged; Parathyroid Hormone; Tomography, X-Ray Computed; Vitamin D

Of the 13 reported cases of hypercalcemia associated with fungal infection, 1 was caused by Cryptococcus neoformans and probably mediated by increased levels of 1,25-dihydroxyvitamin D [1,25(OH)2D]. Eight others were associated with Coccidioides immitis, of which only 2 had measured 1,25(OH)2D levels; in both, they were diminished. We report a patient with human immunodeficiency virus infection and simultaneous C. immitis and C. neoformans pneumonia and C. immitis fungemia associated with hypercalcemia.. Consecutive measurements of serum total and ionized calcium, phosphorous, blood urea nitrogen, creatinine, 25(OH)D, 1,25(OH)2D, parathyroid hormone (PTH), parathyroid hormone-related protein (PTHrp) and albumin were performed over a period of 46 months.. While the patient was hypercalcemic, intact serum PTH and PTHrp were undetectable, serum 25(OH)D levels were normal, and serum 1,25(OH)2D levels were in the high normal range. Successful treatment of the C. immitis and C. neoformans infections resulted in resolution of the hypercalcemia and increase of PTH and PTHrp to the normal range.. In some patients with HIV infection, coincident hypercalcemia, and severe fungal infection, the responsible factor may be 1,25(OH)2D. Although total serum levels of this compound may not be frankly elevated, they are inappropriately high for the circumstances. Free 1,25(OH)2D levels should be determined in this situation.

Topics: Adult; AIDS-Related Opportunistic Infections; Coccidioidomycosis; Cryptococcosis; Cryptococcus neoformans; Humans; Hypercalcemia; Lung Diseases, Fungal; Male; Parathyroid Hormone; Parathyroid Hormone-Related Protein; Proteins; Vitamin D