Severe hypercalcemia preceding a diagnosis of Pneumocystis jirovecii pneumonia in a liver transplant recipient
Identifieur interne : 000433 ( Main/Exploration ); précédent : 000432; suivant : 000434Severe hypercalcemia preceding a diagnosis of Pneumocystis jirovecii pneumonia in a liver transplant recipient
Auteurs : Amy A. Yau ; Samira S. FaroukSource :
- BMC Infectious Diseases [ 1471-2334 ] ; 2019.
Abstract
Incidence of the opportunistic infection
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.
Url:
DOI: 10.1186/s12879-019-4370-z
PubMed: 31438872
PubMed Central: 6704494
Affiliations:
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Farouk</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31438872</idno><idno type="pmc">6704494</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704494</idno><idno type="RBID">PMC:6704494</idno><idno type="doi">10.1186/s12879-019-4370-z</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000012</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000012</idno><idno type="wicri:Area/Pmc/Curation">000012</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000012</idno><idno type="wicri:Area/Pmc/Checkpoint">000390</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000390</idno><idno type="wicri:Area/Ncbi/Merge">000951</idno><idno type="wicri:Area/Ncbi/Curation">000951</idno><idno type="wicri:Area/Ncbi/Checkpoint">000951</idno><idno type="wicri:Area/Main/Merge">000433</idno><idno type="wicri:Area/Main/Curation">000433</idno><idno type="wicri:Area/Main/Exploration">000433</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Severe hypercalcemia preceding a diagnosis of <italic>Pneumocystis jirovecii</italic> pneumonia in a liver transplant recipient</title><author><name sortKey="Yau, Amy A" sort="Yau, Amy A" uniqKey="Yau A" first="Amy A." last="Yau">Amy A. Yau</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Farouk, Samira S" sort="Farouk, Samira S" uniqKey="Farouk S" first="Samira S." last="Farouk">Samira S. Farouk</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p id="Par1">Incidence of the opportunistic infection <italic>Pneumocystis jirovecii</italic> pneumonia (PJP) in solid organ transplant patients ranges from 5 to 15% with a mortality of up to 38%.</p></sec><sec><title>Case presentation</title><p id="Par2">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.</p></sec><sec><title>Conclusions</title><p id="Par3">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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Sokulska, M" uniqKey="Sokulska M">M Sokulska</name></author><author><name sortKey="Kicia, M" uniqKey="Kicia M">M Kicia</name></author><author><name sortKey="Wesolowska, M" uniqKey="Wesolowska M">M Wesołowska</name></author><author><name sortKey="Hendrich, Ab" uniqKey="Hendrich A">AB Hendrich</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kostakis, Id" uniqKey="Kostakis I">ID 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sortKey="Farouk, Samira S" sort="Farouk, Samira S" uniqKey="Farouk S" first="Samira S." last="Farouk">Samira S. 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