Spindel S J, Hamill R J, Georghiou P R, Lacke C E, Green L K, Mallette L E
Section of Infectious Disease, Veterans Affairs Medical Center, Houston, TX 77030, USA.
Am J Med Sci. 1995 Aug;310(2):71-6. doi: 10.1097/00000441-199508000-00007.
Hypercalcemia has been well described in a variety of neoplastic and granulomatous diseases. One mechanism for this hypercalcemia is via the excess production of 1,25-dihydroxyvitamin D from extra-renal sources. The authors describe an AIDS patient infected with Cryptococcus neoformans who had suggestive evidence of vitamin D-mediated hypercalcemia. He had an elevated serum 1,25-dihydroxyvitamin D value, a normal 25-hydroxyvitamin D value, and low values for parathyroid hormone and parathyroid hormone-related peptide. Most previously reported cases of hypercalcemia associated with fungal infections did not include sufficient evidence to implicate a role for excess 1,25-dihydroxyvitamin D production, except for two case reports involving patients with hypercalcemia with infections due to Pneumocystis carinii and Candida albicans. The authors' patient's hypercalcemia resolved during treatment of his underlying infection. Patients with hypercalcemia or in whom hypercalcemia develops during a disseminated fungal infection should have vitamin D metabolites measured as part of their work-up.
高钙血症在多种肿瘤性疾病和肉芽肿性疾病中已有详尽描述。这种高钙血症的一种机制是肾外来源过量产生1,25 - 二羟维生素D。作者描述了一名感染新型隐球菌的艾滋病患者，该患者有维生素D介导的高钙血症的提示性证据。他的血清1,25 - 二羟维生素D值升高，25 - 羟维生素D值正常，甲状旁腺激素和甲状旁腺激素相关肽值降低。除了两篇涉及因卡氏肺孢子虫和白色念珠菌感染导致高钙血症患者的病例报告外，大多数先前报道的与真菌感染相关的高钙血症病例没有包括足够的证据表明过量产生1,25 - 二羟维生素D起到了作用。作者的患者在治疗其基础感染期间高钙血症得到缓解。高钙血症患者或在播散性真菌感染期间出现高钙血症的患者，在其检查过程中应检测维生素D代谢产物。
