Hypercalcemia in patients with disseminated coccidioidomycosis.
OBJECTIVE
Granulomatous disorders may be associated with hypercalcemia. In sarcoidosis, the pathogenesis of hypercalcemia has been clarified, whereas in other granulomatous disorders, such as coccidioidomycosis, the mechanism is unclear. We present 13 patients with coccidioidomycosis and hypercalcemia to illustrate the clinical course and the mechanism of hypercalcemia.


METHODS
We retrospectively reviewed all patients admitted to Kern Medical Center, a 270-bed public hospital, from 1990 through 1997 with coccidioidomycosis and a serum calcium level of greater than 10.5 mg/dL on at least 3 occasions. In addition, no other causes for hypercalcemia were identified.


RESULTS
The mean highest serum calcium level was 12.7 +/- 1.8 mg/dL. All patients had disseminated disease. Six patients were nonambulatory and 4 had bone involvement. Of the 9 patients in whom parathyroid hormone was measured, it was normal in 6 and suppressed in 3. Of the 9 patients in whom 25-hydroxyvitamin D was measured, it was normal in 6, suppressed in 2, and elevated in 1. Of the 7 patients in whom 1,25-dihydroxyvitamin D was measured, it was normal in 3 and suppressed in 4. Urinary calcium was elevated in 2 patients, both of whom were ambulatory. Nonambulatory patients had significantly higher serum calcium levels (14.3 +/- 1.0 mg/dL) than ambulatory patients (11.3 +/- 0.46 mg/dL) (P<0.001).


CONCLUSIONS
The mechanism of hypercalcemia in coccidioidomycosis is unrelated to increased production of 1,25-dihydroxyvitamin D. Nonambulatory status is associated with higher mean serum calcium.
Caldwell
John W
JW
Department of Internal Medicine, Kern Medical Center, Bakersfield, CA, USA.
Arsura
Edward L
EL
Kilgore
William B
WB
Reddy
Chakradhar M
CM
Johnson
Royce H
RH
D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood*; D003047:Coccidioidomycosis / Q000097:blood / Q000150:complications*; D004164:Diphosphonates / Q000627:therapeutic use; D012968:Etidronic Acid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D000077268:Pamidronate; D010281:Parathyroid Hormone / Q000097:blood; D012189:Retrospective Studies; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
D004164:Diphosphonates; D010281:Parathyroid Hormone; D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D; D012968:Etidronic Acid; D000077268:Pamidronate; D002118:Calcium