Hypercalcemia in a patient with disseminated paracoccidioidomycosis: a case report.
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.
Almeida
Rafael Moura
RM
Department of Internal Medicine, State University of Campinas, 13081-970 Campinas, SP, Brazil. rafaelmouraa@yahoo.com.br
Cezana
Loureno
L
Tsukumo
Daniela Miti Lemos
DM
de Carvalho-Filho
Marco Antônio
MA
Saad
Mário José Abdalla
MJ