Life-Threatening Hypercalcemia During Prodrome of Pneumocystis jiroveci Pneumonia in an Immunocompetent Infant

Global Pediatric Health
Judith Sebestyen VanSickleUri S Alon

Abstract

Severe hypercalcemia in infants is usually attributed to genetic etiologies and less commonly to acquired ones. An 8-week-old girl presented with failure to thrive, mild respiratory distress, and life-threatening hypercalcemia (23.5 mg/dL). Serum 1,25(OH)2-vitamin D (1,25(OH)2-D) level was elevated and parathyroid hormone undetectable. Evaluation for genetic mutations and malignant etiologies of hypercalcemia was negative. Treatment with intravenous hydration, loop diuretic, and calcitonin failed to correct the hypercalcemia, which was subsequently controlled with bisphosphonate therapy. Due to progressive respiratory deterioration, a bronchopulmonary lavage was done on day 17 of her hospitalization disclosing Pneumocystis jiroveci infection. The subsequent immunological investigation showed no abnormalities. She was treated with trimethoprim/sulfamethoxazole resulting in gradual clearing of her lungs and normalization of serum 1,25(OH)2-D level. A year later, she remains healthy with normal biochemical parameters of mineral metabolism. We conclude that in a child with hypercalcemia with suppressed parathyroid hormone and elevated 1,25(OH)2-D, once the genetic etiology for elevated 1,25(OH)2-D and malignancy are ruled out, one ...Continue Reading

References

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Mar 20, 2008·Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research·John S AdamsMartin Hewison
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Jun 17, 2011·The New England Journal of Medicine·Karl P SchlingmannMartin Konrad
Sep 1, 2012·Clinical Pediatrics·Judith F SebestyenUri S Alon
Feb 1, 2015·The Journal of Steroid Biochemistry and Molecular Biology·Hemamalini KethaRavinder J Singh

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Citations

Mar 21, 2019·Transplant Infectious Disease : an Official Journal of the Transplantation Society·Lindsay N TaylorKristine M Matson

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Methods Mentioned

BETA
X-ray
lavage
biopsy

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