| Autor: |
nnJonathan Ling, Anderson, Tara, Warren, Sanchia, Kirkland, Geoffrey, Jose, Matthew, Richard Yu, Steven Yew, Mcfadyen, Samantha, Graver, Alison, Johnson, William, Jeffs, Lisa |
| Předmět: |
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| Zdroj: |
Clinical Kidney Journal; Dec2017, Vol. 10 Issue 6, p845-851, 7p |
| Abstrakt: |
Background: The overall incidence of Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients is 5-15%. A timely diagnosis of PJP is difficult and relies on imaging and detection of the organism. Methods: We present a case series of four patients displaying hypercalcaemia with an eventual diagnosis of PJP and document the management of the outbreak with a multidisciplinary team approach. We discuss the underlying pathophysiology and previous reports of hypercalcaemia preceding a diagnosis of PJP. We also reviewed the evidence concerning PJP diagnosis and treatment. Results: Within our renal transplant cohort, four patients presented within 7 months with hypercalcaemia followed by an eventual diagnosis of PJP. We measured their corrected calcium, parathyroid hormone (PTH), 1,25-dihydroxycholecalciferol [1,25-(OH)2D3] and 25-hydroxycholecalciferol [25(OH)D] levels at admission and following treatment of PJP. All four patients diagnosed with PJP were 4-20 years post-transplantation. Three of the four patients demonstrated PTH-independent hypercalcaemia (corrected calcium >3.0 mmol/L). The presence of high 1,25(OH)2D3 and low 25(OH)D levels suggest negation of the negative feedback mechanism possibly due to an extrarenal source; in this case, the alveolar macrophages. All four patients had resolution of their hypercalcaemia after treatment of PJP [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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