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Severe hypercalcemia preceding a diagnosis of Pneumocystis jirovecii pneumonia in a liver transplant recipient.
BMC Infect Dis ; 19(1): 739, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438872
ABSTRACT

BACKGROUND:

Incidence of the opportunistic infection Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant patients ranges from 5 to 15% with a mortality of up to 38%.CASE PRESENTATION: We present a liver transplant recipient who developed hypoxemic respiratory failure related to PJP soon after treatment for allograft rejection. His presentation was preceded by severe hypercalcemia of 14.6 mg/dL and an ionized calcium of 1.7 mmol/L which remained elevated despite usual medical management and eventually required renal replacement therapy. As approximately 5% of PJP cases have granulomas, here we review the role of pulmonary macrophages and inflammatory cytokines in the pathophysiology of granuloma-mediated hypercalcemia. We also discuss the interpretation of our patient's laboratory studies, response to medical therapy, and clinical risk factors which predisposed him to PJP.

CONCLUSIONS:

It is important for clinicians to consider PJP as an etiology of granulomatous pneumonia and non-parathyroid hormone mediated hypercalcemia in chronically immunosuppressed organ transplant recipients for timely diagnosis and management.
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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Pneumonia por Pneumocystis / Transplante de Fígado / Pneumocystis carinii / Sintomas Prodrômicos / Transplantados / Hipercalcemia Tipo de estudo: Relato de casos Aspecto clínico: Diagnóstico / Etiologia Limite: Idoso / Humanos / Masculino Idioma: Inglês Revista: BMC Infect Dis Assunto da revista: Doenças Transmissíveis Ano de publicação: 2019 Tipo de documento: Artigo País de afiliação: Estados Unidos