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首页> 外文期刊>BMC Infectious Diseases >Severe hypercalcemia preceding a diagnosis of Pneumocystis jirovecii pneumonia in a liver transplant recipient
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Severe hypercalcemia preceding a diagnosis of Pneumocystis jirovecii pneumonia in a liver transplant recipient

机译：在肝移植受者被诊断为吉氏肺孢子虫肺炎之前出现严重高钙血症

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摘要

Incidence of the opportunistic infection Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant patients ranges from 5 to 15% with a mortality of up to 38%. We present a liver transplant recipient who developed hypoxemic respiratory failure related to PJP soon after treatment for allograft rejection. His presentation was preceded by severe hypercalcemia of 14.6?mg/dL and an ionized calcium of 1.7?mmol/L which remained elevated despite usual medical management and eventually required renal replacement therapy. As approximately 5% of PJP cases have granulomas, here we review the role of pulmonary macrophages and inflammatory cytokines in the pathophysiology of granuloma-mediated hypercalcemia. We also discuss the interpretation of our patient’s laboratory studies, response to medical therapy, and clinical risk factors which predisposed him to PJP. It is important for clinicians to consider PJP as an etiology of granulomatous pneumonia and non-parathyroid hormone mediated hypercalcemia in chronically immunosuppressed organ transplant recipients for timely diagnosis and management.
机译：实体器官移植患者中机会性感染吉氏肺孢子虫肺炎（PJP）的发生率范围为5％至15％，死亡率高达38％。我们介绍了同种异体移植排斥反应治疗后不久发生与PJP相关的低氧性呼吸衰竭的肝移植受者。在他的诊治之前，严重的高钙血症为14.6？mg / dL，离子钙为1.7？mmol / L，尽管经过常规的医疗管理后仍然升高，最终需要进行肾脏替代治疗。由于大约5％的PJP病例患有肉芽肿，因此我们在此回顾了肺巨噬细胞和炎性细胞因子在肉芽肿介导的高钙血症的病理生理中的作用。我们还将讨论对患者实验室研究的解释，对药物治疗的反应以及使他倾向于PJP的临床危险因素。对于临床医生而言，重要的是将PJP视为慢性免疫抑制器官移植接受者中肉芽肿性肺炎和非甲状旁腺激素介导的高钙血症的病因，以便及时诊断和处理。

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