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Hypercalcemia as a rare manifestation of immune reconstitution inflammatory syndrome (IRIS) in a person living with Human Immunodeficiency Virus (HIV) with disseminated nontuberculous mycobacteriosis. | LitMetric

AI Article Synopsis

  • A case was reported of a 39-year-old male living with HIV who developed hypercalcemia and acute kidney damage due to immune reconstitution inflammatory syndrome (IRIS) and disseminated Mycobacterium avium infection.
  • The patient experienced significant weight loss, muscle weakness, and had laboratory findings confirming high serum calcium levels and kidney damage despite being on antiretroviral therapy and other medications.
  • Treatment involving diuretics, bisphosphonates, and calcitonin successfully normalized calcium levels and improved kidney function, highlighting the rare but critical nature of hypercalcemia linked to IRIS in HIV patients.

Article Abstract

Introduction: Granulomatosis due to immune reconstitution inflammatory syndrome (IRIS) and disseminated Mycobacterium avium-intracellulare (M. avium) infection may trigger hypercalcemia. Here, we report a rare case of hypercalcemia and acute kidney damage related to IRIS in a person living with Human Immunodeficiency Virus (HIV).

Case Presentation: A 39-year-old male person living with HIV presented with muscle weakness and unwanted weight loss of 8 kg within the last 2 weeks. Laboratory findings included serum hypercalcemia of 3.27 mmol/mL associated with elevated calcitriol and acute kidney damage. Since the first diagnosis of HIV and concomitant disseminated M. avium infection, the patient received antiretroviral therapy (ART), rifabutin, clarithromycin, and ethambutol. Fluoro-D-glucose positron emission computed tomography (FDG-PET/CT) showed progressive multilocular lymphadenopathy. Biopsy specimen from the duodenum as well as retroperitoneal and mediastinal lymph nodes revealed granulomatous inflammation consistent with IRIS. Treatment with forced diuresis, bisphosphonates, and calcitonin normalized serum calcium and kidney function recovered.

Conclusion: Hypercalcemia due to IRIS is a rare differential diagnosis in persons living with HIV and may lead to acute kidney damage, despite sufficient ART and antimycobacterial treatment.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289046PMC
http://dx.doi.org/10.1007/s15010-024-02228-7DOI Listing

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