<i>Mycobacterium avium-intracellulare</i> and the unpredictable course of hypercalcemia in an AIDS patient

Ayoubieh, Houriya; Alkhalili, Eyas

doi:10.1016/j.bjid.2016.08.002

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Brazilian Journal of Infectious Diseases

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Case reports • Braz J Infect Dis 21 (1) • Jan-Feb 2017 • https://doi.org/10.1016/j.bjid.2016.08.002 copy

Mycobacterium avium-intracellulare and the unpredictable course of hypercalcemia in an AIDS patient

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

A 37-year-old man with AIDS presented with altered mental status four weeks after stopping his medications for Mycobacterium avium-intracellulare (MAI). He had low CD4 cell count and severe hypercalcemia. Bone marrow biopsy revealed bone marrow infiltration by granulomas positive for acid-fast bacilli and cultures grew MAI. His hypercalcemia continued to worsen with the initiation of MAI therapy but we were able to treat it successfully with pamidronate and calcitonin.

Keywords:
Hypercalcemia; AIDS; Mycobacterium infection

Study	Timeframe of MAI diagnosis in relation to hypercalcemia	Potential hypercalcemia trigger	Hypercalcemia treatment
Tsao et al. ⁶6 Tsao YT, Lee SW, Hsu JC, Ho FM, Wang WJ. Surviving a crisis of HIV-associated immune reconstitution syndrome. Am J Emerg Med. 2012;30:1661.e5-1661.e7.	At presentation	Starting HAART with subsequent development of IRIS	Steroids
Shrayyef et al. ³3 Shrayyef MZ, DePapp Z, Cave WT, Wittlin SD. Hypercalcemia in two patients with sarcoidosis and Mycobacterium avium intracellulare not mediated by elevated vitamin D metabolites. Am J Med Sci. 2011;342:336-40.	At presentation	Initiation of vitamin D and calcium supplementation three weeks prior	Unknown
Choudhary et al. ⁷7 Choudhary M, Rose F. Posterior reversible encephalopathic syndrome due to severe hypercalcemia in AIDS. Scand J Infect Dis. 2005;37(6–7):524-6.	Six months prior	Changes in MAI therapy	Steroids
Playford et al. ⁸8 Playford EG, Bansal AS, Looke DF, Whitby M, Hogan PG. Hypercalcaemia and elevated 1,25(OH)(2)D(3) levels associated with disseminated Mycobacterium avium infection in AIDS. J Infect. 2001;42:157-8.
Case 1	Four months prior	Changes in MAI therapy	Bisphosphonate
Case 2	Four weeks prior	Initiating MAI therapy	Bisphosphonate
Aly et al. ⁴4 Aly ES, Baig M, Khanna D, Baumann MA. Hypercalcaemia: a clue to Mycobacterium avium intracellulare infection in a patient with AIDS. Int J Clin Pract. 1999;53:227-8.	At presentation	Six months after starting HAART	Bisphosphonate
Newell et al. ¹²12 Newell A, Nelson MR. Hypercalcaemia in a patient with AIDS and Mycobacterium avium intracellulare infection. Int J STD AIDS. 1997;8:405.	Six months prior	Unknown	Bisphosphonate
Delahunt et al. ⁵5 Delahunt JW, Romeril KE. Hypercalcemia in a patient with the acquired immunodeficiency syndrome and Mycobacterium avium intracellulare infection. J Acquir Immune Defic Syndr. 1994;7:871-2.	At presentation	Unknown	Bisphosphonate and steroids

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[1] *Corresponding author. E-mail address: hayoubieh@salud.unm.edu, h.ayoubieh@gmail.com (H. Ayoubieh).