播散性副球孢子菌病患者的高钙血症：一例报告
Hypercalcemia in a patient with disseminated paracoccidioidomycosis: a case report.
作者信息
Almeida Rafael Moura, Cezana Loureno, Tsukumo Daniela Miti Lemos, de Carvalho-Filho Marco Antônio, Saad Mário José Abdalla
机构信息
Department of Internal Medicine, State University of Campinas, 13081-970 Campinas, SP, Brazil.
出版信息
J Med Case Rep. 2008 Aug 8;2:262. doi: 10.1186/1752-1947-2-262.
INTRODUCTION
Hypercalcemia is well described in various granulomatous disorders, such as sarcoidosis, tuberculosis, berylliosis, leprosy and fungal infections. However, the association of Paracoccidioides brasiliensis and hypercalcemia is rare: to the best of our knowledge, only two cases have previously been reported, and neither had a clear documentation of the etiology of the hypercalcemia.
CASE PRESENTATION
We report the case of a 22-year-old man in whom disseminated infection with paracoccidioidomycosis was associated with hypercalcemia. The patient had a high normal serum level of 1,25-dihydroxyvitamin D and a suppressed parathyroid hormone value, an indication that the hypercalcemia was not mediated by parathyroid hormone and might be associated with 1,25-dihydroxyvitamin D.
CONCLUSION
The episode resolved readily with administration of corticosteroids, an outcome suggesting that this is an effective treatment of hypercalcemia of this origin. On follow-up, while receiving antifungal therapy for P. brasiliensis the patient's calcium values remained normal.
引言
高钙血症在多种肉芽肿性疾病中已有充分描述，如结节病、结核病、铍中毒、麻风病和真菌感染。然而，巴西副球孢子菌与高钙血症的关联较为罕见：据我们所知，此前仅报道过两例，且均未明确记录高钙血症的病因。
病例报告
我们报告一例22岁男性，播散性副球孢子菌病感染伴高钙血症。患者血清1,25 - 二羟维生素D水平略高于正常，甲状旁腺激素值降低，这表明高钙血症并非由甲状旁腺激素介导，可能与1,25 - 二羟维生素D有关。
结论
给予皮质类固醇后病情迅速缓解，这表明这是治疗此类高钙血症的有效方法。随访期间，患者在接受针对巴西副球孢子菌的抗真菌治疗时，血钙值保持正常。
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