title: Hypercalcemia in a patient with disseminated paracoccidioidomycosis: a case report.
abstract: BACKGROUND
  Hypercalcemia is well described in various granulomatous disorders, such as sarcoidosis, tuberculosis, berylliosis, leprosy and fungal infections. However, the association of Paracoccidioides brasiliensis and hypercalcemia is rare: to the best of our knowledge, only two cases have previously been reported, and neither had a clear documentation of the etiology of the hypercalcemia.
  
  
  METHODS
  We report the case of a 22-year-old man in whom disseminated infection with paracoccidioidomycosis was associated with hypercalcemia. The patient had a high normal serum level of 1,25-dihydroxyvitamin D and a suppressed parathyroid hormone value, an indication that the hypercalcemia was not mediated by parathyroid hormone and might be associated with 1,25-dihydroxyvitamin D.
  
  
  CONCLUSIONS
  The episode resolved readily with administration of corticosteroids, an outcome suggesting that this is an effective treatment of hypercalcemia of this origin. On follow-up, while receiving antifungal therapy for P. brasiliensis the patient's calcium values remained normal.
authors.affiliation: Department of Internal Medicine, State University of Campinas, 13081-970 Campinas, SP, Brazil. rafaelmouraa@yahoo.com.br
authors.forename: Rafael Moura
authors.initials: RM
authors.lastname: Almeida
authors.forename: Loureno
authors.initials: L
authors.lastname: Cezana
authors.forename: Daniela Miti Lemos
authors.initials: DM
authors.lastname: Tsukumo
authors.forename: Marco Antônio
authors.initials: MA
authors.lastname: de Carvalho-Filho
authors.forename: Mário José Abdalla
authors.initials: MJ
authors.lastname: Saad