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Abstract: PO2477

Hypercalcemia Associated with Pneumocystis jirovecii Pneumonia in Renal Transplant Patients

Session Information

Category: Trainee Case Report

  • 1902 Transplantation: Clinical

Authors

  • Gilligan, Sarah, University of Utah Health, Salt Lake City, Utah, United States
  • Hartley, Robert C., University of Utah Health, Salt Lake City, Utah, United States
  • Shihab, Fuad S., University of Utah Health, Salt Lake City, Utah, United States
  • Raghavan, Divya, University of Utah Health, Salt Lake City, Utah, United States
  • Hall, Isaac E., University of Utah Health, Salt Lake City, Utah, United States
  • Al-Rabadi, Laith, University of Utah Health, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah Health, Salt Lake City, Utah, United States
Introduction

Pneumocystis jirovecii pneumonia (PJP) is a common complication following solid organ transplantation with an estimated incidence of 5-15%. Although previously reported, hypercalcemia is not classically a sign of PJP. In the past 6 months at our institution, there have been six cases of PJP presenting with varying degrees of hypercalcemia.

Case Description

All patients in the table below presented with signs and symptoms concerning for pneumonia and were diagnosed with PJP by DFA and/or PCR from induced sputum or bronchoscopy. Patient demographics, labs, and calcium trends are outlined in the table. All patients were treated with Bactrim and prednisone for PJP (some later converted to alternative therapy); patients 1 and 2 were also given intravenous fluids and calcitonin specifically for treatment of their hypercalcemia. Patient 6 was initially thought to have aspiration pneumonia but was hypercalcemic on presentation. Because of our experience with the previous patients, when we noted elevated 1,25 vitamin D this prompted testing for PJP, which returned positive.

Discussion

PJP is a common infection following renal transplant and carries significant risk of morbidity and mortality, reported at 13-38%. The diagnosis of PJP can be challenging and confirmatory testing from induced sputum or bronchoscopy may take several days to result. Hypercalcemia has been reported in patients with PJP and is associated with elevated 1,25 OH vitamin levels, likely due to increased activity of 1-alpha hydroxylase in alveolar macrophages. Recognition of hypercalcemia in patients presenting with clinical features concerning for PJP can aid in early diagnosis and treatment.