Hypercalcemia and Fever in a Kidney Transplant Recipient

What is it about?

Following kidney transplantation (KT), hypercalcemia is frequently observed in the first year, typically due to hyperparathyroidism. Traditionally, Pneumocystis jirovecii pneumonia (PJP) and Cytomegalovirus (CMV) posed significant infectious risks. However, the implementation of prophylactic regimens with valganciclovir and TMP/SMX has substantially reduced their prevalence._x000D_ _x000D_ This report presents a case of KT complicated by PJP, with hypercalcemia serving as a potential diagnostic indicator. The observed laboratory profile – hypercalcemia, elevated 1,25-dihydroxyvitamin D, and low 25-hydroxyvitamin D levels – aligns with the hypothesis of increased conversion of native vitamin D to its active form by activated macrophages within granulomatous tissue, a proposed mechanism for PJP-associated hypercalcemia. This case underscores the importance of continued adherence to prophylactic medications and the potential for PJP to manifest as hypercalcemia in the post-transplant population.

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