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Abstract：
Pneumocystis jirovecii pneumonia (PJP) is a rare but serious complication of immunosuppression post-solid organ transplantation. We present a case of refractory, severe hypercalcaemia due to PJP in a renal transplant recipient. Treatment of PJP led to normalisation of the patient\'s calcium levels, and clinical improvement. To further explore the proposed calcitriol-driven mechanism leading to hypercalcaemia in PJP, we performed biochemical analysis on pre- and post-treatment serum and bronchoalveolar lavage sample at the time of PJP diagnosis. We confirmed high circulating and pulmonary levels of calcitriol in acute, untreated PJP with severe hypercalcaemia. PJP treatment led to reduction of circulating calcitriol to within normal range. We present this case, together with a literature review of similar reported cases, and the novel biochemical evidence supporting extra-renal production of calcitriol by activated pulmonary macrophages as the mechanism underpinning hypercalcaemia in PJP.
摘要：
肺孢子虫肺炎（PJP）是实体器官移植后免疫抑制的罕见但严重的并发症。我们提出了一个难处理的案例，肾移植受者因PJP引起的严重高钙血症。PJP的治疗导致患者的钙水平正常化，和临床改善。为了进一步探讨骨化三醇驱动的导致PJP高钙血症的机制，我们在诊断PJP时对治疗前后血清和支气管肺泡灌洗样本进行了生化分析.我们证实了急性时的高循环和肺水平骨化三醇，未经治疗的PJP伴严重高钙血症。PJP治疗导致循环骨化三醇降低至正常范围内。我们提出这个案例，以及对类似病例的文献综述，以及新的生化证据支持激活的肺巨噬细胞在肾外产生骨化三醇是PJP高钙血症的基础。
