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Case report
Pneumocystis jirovecii pneumonitis: cause of acute hypercalcaemia in chronic haemodialysis patient
  1. Florian Garo1,
  2. Cedric Aglae1,2,
  3. Pedram Ahmadpoor1 and
  4. Olivier Moranne1,2
  1. 1Departement of Nephrology, Dialysis and Apheresis, Centre Hospitalier Universitaire de Nimes, Nimes, France
  2. 2Faculte de Medecine, Universite de Montpellier, Montpellier, France
  1. Correspondence to Dr Florian Garo; florian.garo{at}chu-nimes.fr

Abstract

A 76-year-old renal transplant patient due to autosomal dominant polycystic kidney disease who resumed chronic haemodialysis was admitted to our hospital for confusion and lassitude. He was afebrile and physical examination revealed diffuse bilateral rales with decreased respiratory sounds in lower right lung. Laboratory data showed hypercalcaemia (total calcium 3.92 mmol/L (normal range 2.2–2.6 mmol/L), ionised calcium 1.87 mmol/L (1.15–1.35 mmol/L)), low intact parathyroid hormone (iPTH) 15 ng/L, (15–65 ng/L) and high 1,25(OH)2D3 128.9 pg/mL, (15.2–90.1 pg/mL). Chest CT-scan revealed bilateral apical lung lesions after 15 days of antibiotics. Bronchoalveolar sample was PCR positive for Pneumocystis jirovecii. He was treated with an extra session of haemodialysis with 1.25 mmol/L dialysate calcium concentration, oral trimethoprim-sulfamethoxazole was started and oral corticosteroid dose increased to 1 mg/kg for 1 week. Hypercalcaemia decreased progressively after initiation of these treatments. We concluded a case of hypercalcaemia secondary to P. jirovecii infection.

  • infectious diseases
  • immunology
  • dialysis
  • fluid electrolyte and acid–base disturbances
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Footnotes

  • Twitter @garoflorian

  • Contributors FG write the case. CA, PA and OM reviewing case. All authors taking care of patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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