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Hypercalcemia Heralding Pneumocystis jirovecii Pneumonia in an HIV-Seronegative Patient with Diffuse Cutaneous Systemic Sclerosis

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Abstract

Pneumocystis pneumonia (PCP) is a life-threatening fungal infection occurring in immunocompromised patients such as HIV-positive patients with low CD4 cell count or patients under heavy immunosuppressive therapy. We report the case of a 59-year-old male with severe diffuse cutaneous systemic sclerosis presenting with asthenia, dry cough and worsening shortness of breath for the last 15 days. Biological studies were remarkable for PTH-independent severe hypercalcemia with low 25-hydroxyvitamin D and a paradoxically elevated 1,25-dihydroxyvitamin D. Early bronchoalveolar lavage allowed for PCP diagnosis and targeted treatment. We discuss the underlying physiopathology and difficulties regarding prophylaxis and treatment.

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Authors and Affiliations

  1. Division of General Internal Medicine and Infectiology, Clinique St-Pierre Ottignies, Avenue Reine Fabiola, 9, 1340, Ottignies, Belgium

    Quentin Binet, Jean-Christophe Marot & Grégoire Wieers

  2. Division of Clinical Biology and Cytology, Clinique St-Pierre Ottignies, Ottignies, Belgium

    Jacques Mairesse

  3. Division of Rheumatology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium

    Marie Vanthuyne

  4. Division of Rheumatology, Grand Hôpital de Charleroi, Gilly, Belgium

    Marie Vanthuyne

Authors
  1. Quentin Binet
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  2. Jacques Mairesse
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Correspondence to Quentin Binet.

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The authors hereby certify that there is no conflict of interest regarding the publication of this paper. It has been written taking into account the checklist implemented by Mycopathologia to ensure consistency and quality across case reports [39].

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Handling Editor: J.-P. Bouchara.

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Binet, Q., Mairesse, J., Vanthuyne, M. et al. Hypercalcemia Heralding Pneumocystis jirovecii Pneumonia in an HIV-Seronegative Patient with Diffuse Cutaneous Systemic Sclerosis. Mycopathologia 184, 787–793 (2019). https://doi.org/10.1007/s11046-019-00397-w

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