PMID- 34703699
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211028
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 9
DP  - 2021 Sep
TI  - Hypercalcemia Secondary to Immune Reconstitution Inflammatory Syndrome in an 
      HIV-Infected Individual With Mycobacterium avium Complex.
PG  - e18174
LID - 10.7759/cureus.18174 [doi]
LID - e18174
AB  - Immune reconstitution inflammatory syndrome (IRIS) is an uncommon cause of 
      hypercalcemia in HIV-infected patients recently started on highly active 
      antiretroviral therapy (HAART). It is hypothesized that increased granulomatous 
      formation due to IRIS leads to an overproduction of calcitriol. High levels of 
      calcitriol, then, can lead to significant hypercalcemia. We present the case of a 
      63-year-old male with HIV off HAART presented to the emergency room for 
      confusion, frequent falls, and cough. His CD-4 count was noted to be below 35 
      cells/microL (255-2,496). Over the course of the hospitalization, the patient 
      was found to have disseminated Mycobacterium avium complex (MAC) infection and 
      was initiated on HAART. Initiation of HAART was followed by an increase in 
      calcium up to 14.1 mg/dL. The hypercalcemia did not respond to either Calcitonin 
      or Pamidronate. Consideration was then given to IRIS in the setting of MAC 
      infection leading to increased granulomatous formation. Calcium levels normalized 
      within three days of therapy after initiation of prednisone for the treatment of 
      IRIS.  It is thought that an increase in CD-4 counts leads to the recovery of an 
      immune response. This can lead to granulomatous inflammation. An increase in 
      granuloma formation can cause hypercalcemia due to overproduction of calcitriol 
      via increased 1𝛼-hydroxylase activity from macrophages. Our case report describes 
      IRIS-mediated hypercalcemia in an HIV-infected individual with MAC infection. 
      This unusual cause of severe hypercalcemia should be considered in differential 
      diagnoses for immunocompromised patients in the appropriate setting. Prompt 
      treatment of IRIS with glucocorticoids can lead to the resolution of 
      hypercalcemia.
CI  - Copyright (c) 2021, Awasty et al.
FAU - Awasty, Sanjana S
AU  - Awasty SS
AD  - Division of Internal Medicine, University of Cincinnati Medical Center, 
      Cincinnati, USA.
FAU - Jafri, Sabih
AU  - Jafri S
AD  - Division of Internal Medicine, University of Cincinnati Medical Center, 
      Cincinnati, USA.
FAU - Manzoor, Saima
AU  - Manzoor S
AD  - Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati 
      Medical Center, Cincinnati, USA.
FAU - Yaqub, Abid
AU  - Yaqub A
AD  - Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati, 
      College of Medicine, Cincinnati, USA.
LA  - eng
PT  - Case Reports
DEP - 20210921
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8530549
OTO - NOTNLM
OT  - acute hypercalcemia
OT  - haart
OT  - hiv aids
OT  - immune reconstitution syndrome
OT  - mycobacterium avium intracellulare
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/10/28 06:00
MHDA- 2021/10/28 06:01
PMCR- 2021/09/21
CRDT- 2021/10/27 07:08
PHST- 2021/09/21 00:00 [accepted]
PHST- 2021/10/27 07:08 [entrez]
PHST- 2021/10/28 06:00 [pubmed]
PHST- 2021/10/28 06:01 [medline]
PHST- 2021/09/21 00:00 [pmc-release]
AID - 10.7759/cureus.18174 [doi]
PST - epublish
SO  - Cureus. 2021 Sep 21;13(9):e18174. doi: 10.7759/cureus.18174. eCollection 2021 
      Sep.