Vol. 7, Issue 11, Part B (2021)

Background: Pneumocystis has lung tropism and can cause opportunistic pneumonia. The overall incidence of Pneumocystis jirovecii pneumonia (PCP) in solid organ transplantation is 5 to 15% and mortality rates are 13-38%. A timely diagnosis of PCP is difficult and relies on imaging and detection of organism.

Method: We present a case of patients displaying hypercalcaemia with an eventual diagnosis of PCP and treated with a multidisciplinary team approach. We discuss the underlying pathophysiology of hypercalcaemia preceding a diagnosis of PCP. we also reviewed the evidence concerning PJP diagnosis and treatment.

Results: A 34 yrs. old, post Robotic Assisted Renal transplant surgery presented with hypercalcaemia followed by an eventual diagnosis of PCP. We measured their corrected calcium, parathyroid hormone (PTH), 1,25-dihydroxycholecalciferol [1,25-(OH)₂D₃] and 25-hydroxycholecalciferol [25(OH)D] levels at admission and following treatment of PCP. The patient diagnosed with PCP after post-transplantation. The patient demonstrated PTH-independent hypercalcaemia (corrected calcium >11.1 mg/dl). The presence of high 1,25(OH)₂D₃ and low 25(OH)D levels suggest negation of the negative feedback mechanism possibly due to an extrarenal source; in this case, the alveolar macrophages. The patient resolution of their hypercalcaemia after treatment of PCP.

Conclusions: Hypercalcaemia of an unclear aetiology and refractory to treatment in a renal transplant recipient can be a feature of impending PCP In such cases, diagnosis is made of with Radio imaging (CT) assisted by early bronchoscopy may help in speedy recovery and significantly decreasing morbidity and mortality.