International Journal of Applied Research
Vol. 7, Issue 11, Part B (2021)
Hypercalcemia preceding Pneumocystis jirovecii infection in a young male post renal transplant
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.
How to cite this article:
Prajapati Dhairya, Patil Sudip, Chhabra Gagan Deep, Khullar Dinesh. Hypercalcemia preceding Pneumocystis jirovecii infection in a young male post renal transplant. Int J Appl Res 2021;7(11):92-94.