Diniz Renan Gomes Mendes, Da Silva Betina Nogueira, Domingues-Da-Silva Raoni De Oliveira, Arnone Marcelo, Belda Júnior Walter, Daher Elizabeth De Francesco, Andrade Lucia
Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Am J Trop Med Hyg. 2024 Oct 29;112(1):155-157. doi: 10.4269/ajtmh.24-0456. Print 2025 Jan 8.
Paracoccidioidomycosis is an acute to chronic systemic mycosis caused by the fungi Paracoccidioides. Hypercalcemia is a rare and not fully understood presentation of this infection. We present a case report of paracoccidioidomycosis associated with hypercalcemia and acute kidney injury (AKI) in an immunocompetent patient. An immunocompetent 30-year-old man from Brazil presented with papular erythematous-violaceous skin lesions, disseminated lymphadenopathy, pain in the left hypochondrium, fever with night sweats, and loss of 25 kilograms in 5 months. The result of a biopsy of the lesions was positive for Paracoccidioides brasiliensis. Laboratory findings were high total calcium and 1,25-dihydroxy vitamin D, with low parathyroid hormone, low albumin, and AKI. Computed tomography scans revealed splenic infarcts without bone lesions. Treatment was performed with methylprednisolone and liposomal amphotericin B. Calcium levels and kidney function normalized within 20 days of hospitalization. The patient was discharged 49 days after admission. A follow-up 6 months later revealed total clinical and serological remission.
副球孢子菌病是一种由副球孢子菌引起的从急性到慢性的全身性真菌病。高钙血症是这种感染的一种罕见且尚未完全了解的表现形式。我们报告一例免疫功能正常的患者发生副球孢子菌病并伴有高钙血症和急性肾损伤（AKI）的病例。一名来自巴西的30岁免疫功能正常男性，出现丘疹性红紫色皮肤损害、全身淋巴结肿大、左季肋部疼痛、发热伴盗汗，5个月内体重减轻25千克。病变活检结果显示巴西副球孢子菌阳性。实验室检查发现总钙和1,25 - 二羟维生素D水平升高，甲状旁腺激素水平降低，白蛋白水平降低以及急性肾损伤。计算机断层扫描显示脾梗死但无骨病变。采用甲泼尼龙和脂质体两性霉素B进行治疗。住院20天内钙水平和肾功能恢复正常。患者入院49天后出院。6个月后的随访显示临床和血清学完全缓解。
