title: Pneumocystis jirovecii pneumonia with an atypical granulomatous response after kidney transplantation.
abstract: Pneumocystis jirovecii pneumonia (PCP) continues to be a leading cause of morbidity and mortality in kidney transplant recipients. Granulomatous PCP is an unusual histological presentation that has been described in a variety of immunosuppressive conditions. Previous studies have demonstrated an association between granulomatous disorders and hypercalcemia, the purported mechanism of which is extrarenal production of 1,25-dihydroxyvitamin D by activated macrophages. Here, we report a case of granulomatous formation in a kidney transplant recipient with PCP who presented with hypercalcemia and suppressed parathyroid hormone, both of which resolved after successful treatment of the pneumonia. In immunocompromised patients, pulmonary infection associated with hypercalcemia should raise the suspicion of PCP and other granulomatous disorders.
authors.affiliation: Nephrology Division, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Ramalho
authors.forename: I D
authors.initials: ID
authors.lastname: Bacelar Marques
authors.forename: A R
authors.initials: AR
authors.lastname: Aguirre
authors.forename: L C
authors.initials: LC
authors.lastname: Pierrotti
authors.forename: F J
authors.initials: FJ
authors.lastname: de Paula
authors.forename: W C
authors.initials: WC
authors.lastname: Nahas
authors.forename: E
authors.initials: E
authors.lastname: David-Neto
mesh_terms: D005260:Female; D006099:Granuloma / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000382:microbiology*
keywords: Pneumocystis jirovecii; granuloma; hypercalcemia; kidney transplantation