Huang Jiun-Chi, Kuo Mei-Chuan, Hwang Shang-Jyh, Hwang Daw-Yang, Chen Hung-Chun
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
Intern Med. 2012;51(13):1793-6. doi: 10.2169/internalmedicine.51.7453. Epub 2012 Jul 1.
Hypercalcemia has been described in variety of granulomatous diseases and fungal infections. However, hypercalcemia in pulmonary cryptococcosis is rarely disclosed. We report a 57-year-old HIV-uninfected woman with diabetes, who initially presented with altered mental status, severe hypercalcemia with increased serum 1,25-dihydroxyvitamin D [1,25(OH)₂D] concentration and suppressed parathyroid hormone. Pulmonary cryptococcosis was diagnosed as the cause of hypercalcemia. Successful treatment resulted in the resolution of hypercalcemia and decrease of the serum 1,25(OH₂D concentration to within the normal range. In summary, although HIV infection is a major risk factor for cryptococcosis, vitamin D-mediated hypercalcemia could be the initial presentation of pulmonary cryptococcosis in HIV-negative patients.
高钙血症在多种肉芽肿性疾病和真菌感染中均有报道。然而，肺隐球菌病中的高钙血症却鲜有披露。我们报告一例57岁未感染HIV的糖尿病女性患者，其最初表现为精神状态改变、严重高钙血症，血清1,25 - 二羟维生素D [1,25(OH)₂D]浓度升高且甲状旁腺激素受抑制。肺隐球菌病被诊断为高钙血症的病因。成功治疗使高钙血症得以缓解，血清1,25(OH)₂D浓度降至正常范围。总之，尽管HIV感染是隐球菌病的主要危险因素，但维生素D介导的高钙血症可能是HIV阴性患者肺隐球菌病的首发表现。
