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Case Reports
. 2021 Dec 8;14(12):e245025.
doi: 10.1136/bcr-2021-245025.

Hypercalcaemia associated with disseminated cryptococcosis

Hazwani Aziz  1 , Noor Lita Adam  2 , Nor Afidah Karim  2
Affiliations
Case Reports

Hypercalcaemia associated with disseminated cryptococcosis

Hazwani Aziz et al. BMJ Case Rep. .

Abstract

We report an elderly man who presented with giddiness and right-sided weakness, constipation and constitutional symptoms for 6 months duration. Blood investigations indicated hypercalcaemia with normal serum phosphate and acute kidney injury. Serum intact parathyroid hormone was suppressed. CT revealed bilateral tiny lung nodules with right upper lobe tree in bud appearance and incidental findings of bilateral adrenal lesion. Tuberculosis was ruled out. CT adrenal showed multiseptated hypodense rim enhancement adrenal lesion bilaterally. Adrenal function tests were normal except for low dehydroepiandrosterone (DHEA). Right-sided cervical lymph node biopsy confirmed fungal infection with the presence of intracellular and extracellular fungal yeast. Serum cryptococcus antigen titre was positive. Our final diagnosis was disseminated cryptococcosis with lungs, bilateral adrenal gland and lymph nodes involvement. The patient was then treated with antifungal treatment. Serum calcium was normalised after 1 month with marked clinical improvement.

Keywords: adrenal disorders; calcium and bone; cryptococcosis; cryptococcus.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CT thorax showed diffuse bilateral tiny nodules with right upper lobe tree in bud appearance.
Figure 2
Figure 2
CT adrenal protocol showed multiseptated hypodense rim enhancing adrenal lesions bilaterally. The right adrenal lesion measured 2.7 cm × 2.4 cm × 3.1 cm, with attenuation of 30 HU (plain phase) and total wash out rate of 90%. The left adrenal measured 2.0 cm × 2.4 cm × 2.6 cm, with attenuation of 22 HU (plain phase) and total wash out rate of 100%.
Figure 3
Figure 3
H&E stain ×10 showed granulomatous inflammation.
Figure 4
Figure 4
H&E high power ×40 showed multiple multinucleated giant cells with intracytoplasmic yeast.
Figure 5
Figure 5
Fungal yeasts highlighted by Grocott’s methenamines silver stain.
Figure 6
Figure 6
Fungal yeasts highlighted by periodic acid-Schiff. Yeast cells are coloured in red.
See this image and copyright information in PMC

References

    1. Lafferty FW. Differential diagnosis of hypercalcemia. J Bone Miner Res 1991;6 Suppl 2:S51–9. discussion S61. 10.1002/jbmr.5650061413 - DOI - PubMed
    1. Renaghan AD, Rosner MH. Hypercalcemia: etiology and management. Nephrology Dialysis Transplantation 2018;33:549–51. 10.1093/ndt/gfy054 - DOI
    1. Shane E, Dinaz I. Hypercalcemia: pathogenesis, clinical manifestations, differential diagnosis, and management. In: Favus MJ, ed. Primer on the metabolic bone diseases and disorders of mineral metabolism. 6th edn. Washington, DC: American Society for Bone and Mineral Research, 2006: 176–80.
    1. Stewart AF. Hypercalcemia associated with cancer. N Engl J Med Overseas Ed 2005;352:373–9. 10.1056/NEJMcp042806 - DOI - PubMed
    1. Brandi ML. Parathyroid disorders. focusing on unmet needs. Front Horm Res. Base, Karger 2019;51:77–90.

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