Hypercalcemia associated with infection by Cryptococcus neoformans and Coccidioides immitis.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Ali
M Y
MY
Division of Infectious Disease and Endocrinology, Fairview General Hospital, Cleveland Clinic Health System, Ohio, USA.
Gopal
K V
KV
Llerena
L A
LA
Taylor
H C
HC
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000150:complications* / Q000382:microbiology*; D000328:Adult; D003047:Coccidioidomycosis / Q000150:complications*; D003453:Cryptococcosis / Q000150:complications*; D003455:Cryptococcus neoformans; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000382:microbiology*; D008172:Lung Diseases, Fungal / Q000097:blood / Q000150:complications* / Q000382:microbiology* / Q000473:pathology; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins / Q000378:metabolism; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins; D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D