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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


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.


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.





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