Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/26724
Title: Refractory hypercalcaemia associated with disseminated Cryptococcus neoformans infection.
Austin Authors: Zhu, Jasmine J ;Naughton, William J;Hay Be, Kim;Ensor, Nicholas ;Cheung, Ada S 
Affiliation: Infectious Diseases
Victorian Liver Transplant Unit
Medicine (University of Melbourne)
Issue Date: 1-Jun-2021
Date: 2021-06-01
Publication information: Endocrinology, Diabetes & Metabolism Case Reports 2021; online first: 1 June
Abstract: Hypercalcaemia is a very common endocrine condition, yet severe hypercalcaemia as a result of fungal infection is rarely described. There are have only been two reported cases in the literature of hypercalcaemia associated with Cryptococcus infection. Although the mechanism of hypercalcaemia in these infections is not clear, it has been suggested that it could be driven by the extra-renal production of 1-alpha-hydroxylase by macrophages in granulomas. We describe the case of a 55-year-old woman with a 1,25-OH D-mediated refractory hypercalcaemia in the context of a Cryptococcus neoformans infection. She required treatment with antifungals, pamidronate, calcitonin, denosumab and high-dose glucocorticoids. A disseminated fungal infection should be suspected in immunosuppressed individuals presenting with hypercalcaemia. In immunocompromised patients with unexplained hypercalcaemia, fungal infections should be considered as the differential diagnoses; Glucocorticoids may be considered to treat 1,25-OH D-driven hypercalcaemia; however, the benefits of lowering the calcium need to be balanced against the risk of exacerbating an underlying infection; Fluconazole might be an effective therapy for both treatment of the hypercalcaemia by lowering 1,25-OH D levels as well as of the fungal infection.
URI: https://ahro.austin.org.au/austinjspui/handle/1/26724
DOI: 10.1530/EDM-20-0186
Journal: Endocrinology, Diabetes & Metabolism Case Reports
PubMed URL: 34110303
ISSN: 2052-0573
Type: Journal Article
Appears in Collections:Journal articles

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