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- Title
Hypercalcemia in Disseminated Coccidioidomycosis: Expression of Parathyroid Hormone–Related Peptide Is Characteristic of Granulomatous Inflammation.
- Authors
Fierer, Joshua; Burton, Douglas W.; Haghighi, Parviz; Deftos, Leonard J.
- Abstract
Hypercalcemia is an uncommon complication of disseminated granulmatous infections. We investigated a case of disseminated coccidioidomcosis with hypercalcemia. We propose that excess production of PTHrP is the cause of hypercalcemia in granulomatous infections.Background. Hypercalcemia is an uncommon complication of disseminated granulomatous infections. The pathogenesis of hypercalcemia associated with infection is not clear.Methods. We investigated a case of disseminated coccidioidomycosis with hypercalcemia. We used a sensitive radioimmunoassay to measure serum parathyroid hormone–related peptide (PTHrP) and a mouse monoclonal antibody to PTHrP to immunostain biopsies.Results. We found elevated serum levels of PTHrP while the patient was hypercalcemic that became undetectable when serum calcium normalized. We also found that the inflammatory cells and some surrounding tissues in skin biopsies expressed PTHrP. PTHrP was expressed by all biopsied lesions of patients with coccidioidomycosis that we examined, whether localized to the lung or disseminated, but no other cases were hypercalcemic. PTHrP was also expressed by the 3 mycobacterial granulomas we examined, and in a lymph node from a patient with sarcoidosis.Conclusions. The expression of PTHrP is a property of infectious granulomas regardless of etiology or the tissue involved, suggesting that PTHrP expression is part of the normal granulomatous immune response. Hypercalcemia may result if there is disseminated infection and multiple granulomas. We propose that excess production of PTHrP is the cause of hypercalcemia in granulomatous infections.
- Subjects
HYPERCALCEMIA; CHRONIC granulomatous disease; RADIOIMMUNOASSAY; PARATHYROID hormone; THERAPEUTIC use of monoclonal antibodies; LABORATORY mice
- Publication
Clinical Infectious Diseases, 2012, Vol 55, Issue 7, pe61
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cis536