RESUMO
BACKGROUND: Hypercalcemia is an uncommon finding in people living with HIV (PLHIV). Causes of hypercalcemia in PLHIV have not been well documented. As such, we studied the causes of hypercalcemia in PLHIV. METHODS: We conducted a retrospective review of PLHIV who had corrected serum calcium of ≥10.5 mg/dL between 2010 and 2019. Demographic data, associated diseases, and treatment details were collected. Corrected serum calcium levels were compared among the causes of hypercalcemia. RESULTS: A total of 70 of 2168 (3.2%) PLHIV had hypercalcemia. Forty-nine (70.0%) were male with a mean age of 47.7 ± 4.7 years. Only two (2.9%) had symptoms of hypercalcemia. Fifty-four patients had identifiable causes of hypercalcemia; 21 infections (30.0%), 17 solid organ malignancies (24.3%), 14 hematologic malignancies (20.0%), and two other specific causes (2.9%). Mean corrected serum calcium concentrations of PLHIV who had solid organ malignancy, hematologic malignancy, infection, and unknown causes were 12.8 ± 2.1, 11.4 ± 1.0, 11.2 ± 0.6, and 10.8 ± 0.2 mg/dL, respectively. Corrected serum calcium levels were significantly greater in patients who had solid organ malignancy comparing to those with other causes of hypercalcemia (p < 0.05, all). Logistic regression identified solid organ malignancy as the only factor associated with moderate to severe hypercalcemia (odds ratio 12.72, 95% confidence interval 3.11-52.08; p < 0.001). CONCLUSIONS: Hypercalcemia in PLHIV is associated with solid organ malignancy, hematologic malignancy, and infection. Most PLHIV with hypercalcemia are asymptomatic. Solid organ malignancy is associated with moderate to severe hypercalcemia, and as such PLHIV presenting with moderate to severe hypercalcemia should be investigated for solid organ malignancy.
Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/tratamento farmacológico , Hipercalcemia/etiologia , Adulto , Feminino , Infecções por HIV/sangue , Humanos , Hipercalcemia/virologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Hipercalcemia/etiologia , Síndrome Inflamatória da Reconstituição Imune/complicações , Tuberculose dos Linfonodos/complicações , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , HIV-1 , Humanos , Hipercalcemia/tratamento farmacológico , Hipercalcemia/virologia , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/virologia , Masculino , Mediastino/microbiologia , Mediastino/patologia , Pessoa de Meia-Idade , Tuberculose dos Linfonodos/tratamento farmacológico , Tuberculose dos Linfonodos/imunologia , Tuberculose dos Linfonodos/virologia , Vitamina D/administração & dosagem , Vitamina D/uso terapêuticoAssuntos
Alphapapillomavirus/isolamento & purificação , Doenças do Ânus/virologia , Neoplasias do Ânus/virologia , Carcinoma de Células Escamosas/virologia , Condiloma Acuminado/virologia , Hipercalcemia/virologia , Infecções por Papillomavirus/virologia , Síndromes Paraneoplásicas/virologia , Alphapapillomavirus/genética , Doenças do Ânus/patologia , Doenças do Ânus/terapia , Neoplasias do Ânus/patologia , Neoplasias do Ânus/terapia , Biópsia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Condiloma Acuminado/patologia , Condiloma Acuminado/terapia , DNA Viral/isolamento & purificação , Feminino , Humanos , Hipercalcemia/patologia , Hipercalcemia/terapia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/terapia , Síndromes Paraneoplásicas/patologia , Síndromes Paraneoplásicas/terapia , Resultado do TratamentoAssuntos
Hipercalcemia/virologia , Leucemia-Linfoma de Células T do Adulto/diagnóstico , Doenças Linfáticas/virologia , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/complicações , Adulto , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia por Agulha Fina , Diagnóstico Diferencial , Duodeno/parasitologia , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Vírus Linfotrópico T Tipo 2 Humano/isolamento & purificação , Humanos , Leucemia de Células T/diagnóstico , Leucemia-Linfoma de Células T do Adulto/complicações , Leucemia-Linfoma de Células T do Adulto/tratamento farmacológico , Masculino , PescoçoRESUMO
We experienced a case of adult T cell leukemia/lymphoma (ATLL) in a 48-year-old Korean female, who has never been abroad since birth and no history of blood transfusion. The patient had hypercalcemia and multiple lymphadenopathy. Histopathologic study of left cervical lymph node (LN) and bone marrow (BM) revealed that infiltrates of malignant lymphoid cells were composed of small, medium and large cells with pleomorphic nuclei. Smears of peripheral blood (PB) showed lymphopenia (16%) with the appearance of a few atypical lymphoid cells (less than 2%), but not the typical clover leaf cells seen in ATLL. Immunophenotypic study of LN and BM revealed T cell phenotype. PB showed increased CD4+ T cell (T(H), CD3/CD4+, 57%) and decreased CD8+ T cell counts (T(S), CD3/CD8+, 6.7%). The sera of the patient and her family were reactive for HTLV-I antibody. The specific sequences of pol, env, and tax of HTLV-I DNA were detected in the lymphoma cells and peripheral blood mononuclear cells (PBMC) using polymerase chain reaction. Ultrastructural examination of PBMC confirmed numerous type c virus particles in extracellular space. This case was an acute type of ATLL without overt leukemic features in PB. Despite chemotherapy and intensive conservative treatment, she died 3 months after admission.
Assuntos
Leucemia de Células T/patologia , Linfopenia/patologia , Biópsia , Medula Óssea/patologia , DNA Viral/análise , Infecções por Deltaretrovirus/patologia , Evolução Fatal , Feminino , Citometria de Fluxo , Produtos do Gene env/genética , Produtos do Gene pol/genética , Produtos do Gene tax/genética , Vírus Linfotrópico T Tipo 1 Humano , Humanos , Hipercalcemia/patologia , Hipercalcemia/virologia , Imunofenotipagem , Coreia (Geográfico) , Leucemia de Células T/imunologia , Leucemia de Células T/virologia , Linfonodos/patologia , Linfopenia/imunologia , Linfopenia/virologia , Microscopia Eletrônica , Pessoa de Meia-Idade , Linfócitos T/patologia , Linfócitos T/ultraestrutura , Linfócitos T/virologiaRESUMO
We experienced a case of adult T cell leukemia/lymphoma (ATLL) in a 48-year-old Korean female, who has never been abroad since birth and no history of blood transfusion. The patient had hypercalcemia and multiple lymphadenopathy. Histopathologic study of left cervical lymph node (LN) and bone marrow (BM) revealed that infiltrates of malignant lymphoid cells were composed of small, medium and large cells with pleomorphic nuclei. Smears of peripheral blood (PB) showed lymphopenia (16%) with the appearance of a few atypical lymphoid cells (less than 2%), but not the typical clover leaf cells seen in ATLL. Immunophenotypic study of LN and BM revealed T cell phenotype. PB showed increased CD4+ T cell (T(H), CD3/CD4+, 57%) and decreased CD8+ T cell counts (T(S), CD3/CD8+, 6.7%). The sera of the patient and her family were reactive for HTLV-I antibody. The specific sequences of pol, env, and tax of HTLV-I DNA were detected in the lymphoma cells and peripheral blood mononuclear cells (PBMC) using polymerase chain reaction. Ultrastructural examination of PBMC confirmed numerous type c virus particles in extracellular space. This case was an acute type of ATLL without overt leukemic features in PB. Despite chemotherapy and intensive conservative treatment, she died 3 months after admission.
Assuntos
Feminino , Humanos , Biópsia , Medula Óssea/patologia , DNA Viral/análise , Evolução Fatal , Citometria de Fluxo , Produtos do Gene env/genética , Produtos do Gene pol/genética , Produtos do Gene tax/genética , Infecções por Deltaretrovirus/patologia , Vírus Linfotrópico T Tipo 1 Humano , Hipercalcemia/virologia , Hipercalcemia/patologia , Imunofenotipagem , Coreia (Geográfico) , Leucemia de Células T/virologia , Leucemia de Células T/patologia , Leucemia de Células T/imunologia , Linfonodos/patologia , Linfopenia/virologia , Linfopenia/patologia , Linfopenia/imunologia , Microscopia Eletrônica , Pessoa de Meia-Idade , Linfócitos T/virologia , Linfócitos T/ultraestrutura , Linfócitos T/patologiaRESUMO
Hypercalcemia is uncommon in patients infected with the human immunodeficiency virus (HIV). It has been described in association with cytomegalovirus infection, Pneumocystis carinii pneumonia, granulomatous diseases, and lymphoma. However, symptomatic hypercalcemia as an early sign of an underlying AIDS-related lymphoma is not well documented. We discuss the case of a patient with HIV and hypercalcemia, leading to the diagnosis of an underlying lymphoma. The hypercalcemia was associated with a suppressed serum level of intact parathyroid hormone and a normal serum phosphorus level. The possibility of a lymphoproliferative disorder should be considered in the differential diagnosis of HIV-associated hypercalcemia.
Assuntos
Hipercalcemia/virologia , Linfoma Relacionado a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Linfoma Relacionado a AIDS/diagnóstico , Masculino , Hormônio Paratireóideo/sangueRESUMO
HTLV1 virus is a retrovirus that has been endemic in Africa. It is the responsible for tropical spastic paraparesis and adult's T Cell leukemia-lymphoma. Few cases of adult T-Cell leukemia-lymphoma have been described in Africa, contrary to Japan and Caribbean. Were are reporting two cases of acute adult T-Cell leukemia-lymphoma which characterised by blood lymphoma signs, tumoral nodes and extranods lesions, hypercalcemia and positive retroviral serology of HTLV1 virus. The prognosis of these acute forms was bad after a six month survey approximately. The treatment is disappointing. Investigations of this affection must be carried out in every patient who presents lymphoma manifestations all the more because they are associated with hypercalcemia.