SHM Converge Scientific Abstract ePoster Gallery-PJP in the Bmp: A Rare Cause of Persistent Hypercalcemia

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This case describes a 33-year-old renal transplant recipient with recurrent acute kidney injury and persistent hypercalcemia ultimately caused by Pneumocystis jirovecii pneumonia (PJP), an uncommon etiology of non–PTH-mediated hypercalcemia.<br /><br />He first presented with several weeks of nonproductive cough, dyspnea, congestion, chills, and nausea/vomiting. He was afebrile, had normal oxygenation, and tested positive for rhinovirus. Labs showed AKI and mild hypercalcemia, which improved with IV fluids and supportive care. His immunosuppression was partially reduced, and he was discharged.<br /><br />Four days later, he returned with worsening respiratory and systemic symptoms, including productive cough, dyspnea, chills, nausea/vomiting, low-grade fevers, tachypnea, and new oxygen requirement. Imaging showed bilateral interstitial and ground-glass opacities with nodular consolidations. He again had AKI and higher calcium levels. Despite fluids and empiric antibiotics, his hypercalcemia and kidney injury persisted.<br /><br />Workup revealed suppressed PTH, normal 25-hydroxyvitamin D, and markedly elevated 1,25-dihydroxyvitamin D (calcitriol), suggesting a non-PTH, calcitriol-mediated process. Positive beta-D-glucan and PCR testing from induced sputum and bronchoalveolar lavage confirmed PJP. Treatment-dose trimethoprim-sulfamethoxazole led to rapid resolution of fever, respiratory symptoms, hypoxemia, AKI, and hypercalcemia within four days. Follow-up showed normalization of calcitriol.<br /><br />The authors highlight that PJP can rarely cause hypercalcemia, likely through excess calcitriol production, and may present in immunocompromised patients with respiratory symptoms and unexplained hypercalcemia. Early recognition is important because prompt treatment can significantly reduce morbidity and mortality in transplant recipients.

Asset Subtitle

Asta Gurklys

Meta Tag

Author List Asta Gurklys, Henry R. Kramer, Jason John

Category Clinical Vignettes

Concept Pneumocystis jirovecii pneumonia

Concept Hypercalcemia

Concept Parathyroid Hormone

Concept Immunocompromised State

Concept Transplant Patient

Distinguished Non-Finalist

Presenter Organization University of Colorado, Division of Hospital Medicine

Presenting Author Asta Gurklys

Track Adult

Keywords

renal transplant

acute kidney injury

hypercalcemia

Pneumocystis jirovecii pneumonia

PJP

calcitriol-mediated hypercalcemia

non-PTH-mediated hypercalcemia

immunocompromised

bronchoalveolar lavage

trimethoprim-sulfamethoxazole

Pneumocystis jirovecii pneumonia

Hypercalcemia

Parathyroid Hormone

Immunocompromised State

Transplant Patient