Pneumocystis jirovecii pneumonia with an atypical granulomatous response after kidney transplantation

• Published in: Transplant infectious disease Vol. 16; no. 2; pp. 315 - 319
• Main Authors: Ramalho, J., Bacelar Marques, I.D., Aguirre, A.R., Pierrotti, L.C., Paula, F.J., Nahas, W.C., David‐Neto, E.
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.04.2014
• Subjects: Female; granuloma; Granuloma - microbiology; Granuloma - pathology; Humans; hypercalcemia; Hypercalcemia - etiology; kidney transplantation; Kidney Transplantation - adverse effects; Male; Middle Aged; Pneumocystis; Pneumocystis carinii; Pneumocystis jirovecii; Pneumonia; Pneumonia, Pneumocystis - microbiology; Transplants & implants; hypercalcemia; granuloma; kidney transplantation; Pneumocystis jirovecii
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12198

Pneumocystis jirovecii pneumonia (PCP) continues to be a leading cause of morbidity and mortality in kidney transplant recipients. Granulomatous PCP is an unusual histological presentation that has been described in a variety of immunosuppressive conditions. Previous studies have demonstrated an association between granulomatous disorders and hypercalcemia, the purported mechanism of which is extrarenal production of 1,25‐dihydroxyvitamin D by activated macrophages. Here, we report a case of granulomatous formation in a kidney transplant recipient with PCP who presented with hypercalcemia and suppressed parathyroid hormone, both of which resolved after successful treatment of the pneumonia. In immunocompromised patients, pulmonary infection associated with hypercalcemia should raise the suspicion of PCP and other granulomatous disorders.