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Abstract: SA-PO505

Paracoccidioides brasiliensis Infection, a Tropical Disease Causing Severe Hypercalcemia and AKI: A Case Report

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

  • Diniz, Renan Gomes Mendes, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Andrade, Lucia, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Lutf, Luciana Gil, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Strufaldi, Fernando Louzada, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
Introduction

Paracoccidioidomycosis is a systemic fungal disease that is prevalent in Brazil. Although it can affect multiple organs, the renal and electrolytic effects are not well known.

Case Description

A 30-year-old man from an urban area of the state of São Paulo presented with disseminated papular and nodular skin lesions, some with fistulation and purulent discharge, together with lymph node enlargement, right hypochondrium pain, fever, night sweats, anorexia and weight loss (25 kg). Direct microscopic analysis of the lesions revealed fungal yeast consistent with Paracoccidioides brasiliensis. The patient showed normocytic, normochromic anemia (hemoglobin 7.7 mg/dL) and the following: urea 55 mg/dL; creatinine 1.43 mg/dL; sodium 134 mEq/L; potassium 4.2 mEq/L; total calcium (TCa) 12.6 mg/dL; ionic calcium (iCa) 7.3 mg/dL; phosphorus 3.2 mg/dL; parathyroid hormone <6 pg/mL; 25-hydroxy-vitamin D 17 ng/mL; and alkaline phosphatase 596 U/L. Bilirubin, TSH and urinalysis were all normal. Serology for viruses, syphilis and toxoplasmosis were all negative. His 1,25-dihydroxyvitamin D was elevated (94 ng/dL). A CT scan showed no bone lesions. He received intravenous pamidronate 60 mg and saline infusion. Amphotericin B deoxycholate was prescribed but later switched to amphotericin B lipid complex because the clinical profile had improved. On postadmission day 20, creatinine was 0.77 mg/dL, ICa was 5.82 mg/dL and TCa was 10.2 mg/dL. He was discharged on day 49 with significant improvement of the skin lesions, creatinine of 0.7 mg/dL, ICa of 5.03 mg/dL and TCa of 9.4 mg/dL.

Discussion

We suggest that the hypercalcemia was associated with endogenous release of 1,25-dihydroxyvitamin D from paracoccidioidomycosis lesions. To our knowledge, this is only the third reported case of paracoccidioidomycosis accompanied by hypercalcemia and the only one in which the patient had a high 1,25-dihydroxyvitamin D level.
Although a wide spectrum of neglected tropical diseases are still under investigation, we cannot neglect new findings in this field, given the complexity and peculiarities of this group of diseases. Such findings can allow earlier diagnosis, new discoveries and better treatments.