Vitamin D-mediated hypercalcemia as the initial manifestation of pulmonary cryptococcosis in an HIV-uninfected patient.
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.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
Jiun-Chi
JC
Huang
Mei-Chuan
MC
Kuo
Shang-Jyh
SJ
Hwang
Daw-Yang
DY
Hwang
Hung-Chun
HC
Chen
D003453:Cryptococcosis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology*; D008172:Lung Diseases, Fungal / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D014057:Tomography, X-Ray Computed; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
D010281:Parathyroid Hormone; D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D