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de Lucena LA, de Oliveira FG, de Andrade MMP, de Paula KC, Praxedes MRG, de Oliveira RA. Mucormycosis-induced hypercalcemia: a case report. CEN Case Rep 2024; 13:66-71. [PMID: 37289341 PMCID: PMC10248959 DOI: 10.1007/s13730-023-00800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023] Open
Abstract
Hypercalcemia is a vital laboratory marker because it can show underlying severe diseases like cancer and infections. Of all the causes of hypercalcemia, primary hyperparathyroidism, and malignancies are the most common, but granulomatous diseases, such as certain fungal infections, can also be the cause. Here we describe the case of a 29-year-old woman, an insulin-dependent diabetic, found unconscious and tachypneic at home. In the emergency room, the medical team diagnosed diabetic ketoacidosis (DKA) and acute kidney injury (AKI). During hospitalization, despite resolving acidemia, persistent hypercalcemia attracted attention. Laboratory tests showed decreased parathyroid hormone (PTH) levels, confirming non-PTH-dependent hypercalcemia. Computed tomography (CT) of the chest and abdomen demonstrated no alterations, but an upper digestive endoscopy revealed an ulcerated and infiltrative lesion in the stomach. A biopsy showed a granulomatous infiltrate due to mucormycosis infection. The patient received liposomal amphotericin B for 30 days and isavuconazonium for two months. Serum calcium levels improved during treatment. Inquiry of the etiology of hypercalcemia should begin with the PTH assay; high levels are consistent with hyperparathyroidism; low levels, with calcium or vitamin D intoxication, malignancies, prolonged immobilization, and granulomatous diseases. In the latter cases, the overproduction of 1-alpha-hydroxylase by the granulomatous tissue increases the conversion of 25(OH)vitamin D into 1-25(OH)vitamin D, which causes the intestinal absorption of calcium. We have described the first hypercalcemia related to mucormycosis infection in a young diabetic patient, although case presentations associate other fungal infections with elevated serum calcium.
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Affiliation(s)
- Larissa Araújo de Lucena
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, UFRN - HUOL, Nilo Peçanha Avenue, 620, 3rd underground - Petrópolis, Natal, RN, 59012-300, Brazil
| | | | | | | | | | - Rodrigo Azevedo de Oliveira
- Department of Integrated Medicine, Federal University of Rio Grande do Norte, UFRN - HUOL, Nilo Peçanha Avenue, 620, 3rd underground - Petrópolis, Natal, RN, 59012-300, Brazil.
- Casa de Saúde São Lucas, CSSL, Natal, 59020-160, Brazil.
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Guedes BF, Ribeiro AF, Pinto LF, Vidal JE, de Oliveira FG, Sztajnbok J, de Oliveira ACP, Simabukuro MM. Potential autoimmune encephalitis following yellow fever vaccination: A report of three cases. J Neuroimmunol 2021; 355:577548. [PMID: 33780799 DOI: 10.1016/j.jneuroim.2021.577548] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 01/19/2023]
Abstract
Meningoencephalitis following yellow fever vaccination is considered a viral neuroinvasive disease. We describe three patients with typical autoimmune encephalitis syndromes that developed 1-27 days following yellow fever vaccination. Anti-N-methyl-d-aspartate-r antibodies were identified in the CSF and serum of two patients and the other case was associated with anti-neurexin-3 antibodies. One case was confirmed as vaccine-associated neurotropic disease due to reactive CSF yellow fever IgM, which suggested an infectious-autoimmune overlap mechanism. Two aditional cases of Anti-N-methyl-d-aspartate-r encephalitis were identified in the literature review. Antibody-positive autoimmune encephalitis should be included in the differential diagnosis of neurologic adverse events following yellow fever vaccination.
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Affiliation(s)
- Bruno Fukelmann Guedes
- Departmento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Ana Freitas Ribeiro
- Departamento de Epidemiologia, Instituto de Infectologia Emilio Ribas, São Paulo, Brazil; Universidade Nove de Julho
| | - Lecio Figueira Pinto
- Departmento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Ernesto Vidal
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Departmento de Neurologia, Instituto de Infectologia Emilio Ribas, São Paulo, Brazil; Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana (LIM 49), Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | | | - Jaques Sztajnbok
- Unidade de Terapia Intensiva, Instituto de Infectologia Emilio Ribas, São Paulo, Brazil; Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Mateus Mistieri Simabukuro
- Departmento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Medeiros AC, Azevedo ACB, Oséas JMDF, Gomes MDF, Oliveira FGD, Rocha KBF, Azevedo IM, Rêgo ACM, Carvalho MDF. The ileum positively regulates hepatic regeneration in rats. Acta Cir Bras 2014; 29:93-8. [PMID: 24604312 DOI: 10.1590/s0102-86502014000200004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/20/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To test the hypothesis that liver regeneration after partial hepatectomy can be influenced by the ileum. METHODS Eighteen Wistar rats were distributed into groups of six animals: 1 - ileum resection+ hepatectomy 2/3; 2 - hepatectomy 2/3, and 3 - sham. Anesthesia with ketamine and xylazine i.p., aseptic technique, analgesia with meperidine (10mg/kg s.c.). On day 6, serum ALT, AST, alkaline phosphatase (AP) and albumin were measured. Liver regeneration and hepatocyte mitosis were quantified. Statistical analysis with ANOVA and Tukey tests, with significance p<0.05. RESULTS In group hepatectomy+ileal resection, ALT, AST and AP were 180.6±24.9, 58.6±3.1 and 254.6±46.6 respectively. They were significantly higher than in the hepatectomy group, whose values were 126.0±16.5, 44.1±3.9 and 163.5±8.6, respectively (p<0.001). Albumin levels were not significantly different among groups. Liver regeneration in hepatectomy group (94.17%) was statistically higher (p<0.001) than in ileal resection+hepatectomy group (55.96%). In the latter group the mitosis of hepatocytes were significantly less frequent than in the hepatectomy group. CONCLUSION The data confirm that the ileum positively influence on liver regeneration in rats undergoing hepatectomy.
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Affiliation(s)
- Aldo Cunha Medeiros
- Federal University of Rio Grande do Norte, Department of Surgery, NatalRN, Brazil, Full Professor, Chairman, Department of Surgery, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil. Conception, design, intellectual and scientific content of the study; analysis and interpretation of data; technical procedures; critical revision
| | - Ana Clara Batista Azevedo
- UFRN, NatalRN, Brazil, Graduate student, Scientific Initiation Program, UFRN, Natal-RN, Brazil. Acquisition of data, manuscript preparation
| | - Jéssica Mayara de Figueiredo Oséas
- UFRN, NatalRN, Brazil, Graduate student, Scientific Initiation Program, UFRN, Natal-RN, Brazil. Acquisition of data, manuscript preparation
| | - Mariana Davim Ferreira Gomes
- UFRN, NatalRN, Brazil, Graduate student, Scientific Initiation Program, UFRN, Natal-RN, Brazil. Acquisition of data, manuscript preparation
| | - Fernanda Gurgel de Oliveira
- UFRN, NatalRN, Brazil, Graduate student, Scientific Initiation Program, UFRN, Natal-RN, Brazil. Acquisition of data, manuscript preparation
| | - Keyla Borges Ferreira Rocha
- UFRN, Department of Pathology, NatalRN, Brazil, Associate Professor, Department of Pathology, UFRN, Natal-RN, Brazil. Acquisition and interpretation of data
| | - Italo Medeiros Azevedo
- UFRN, Department of Surgery, NatalRN, Brazil, Master, Statistician, Department of Surgery, UFRN, Natal-RN, Brazil. Design of the study, interpretation of data, statistical analysis
| | - Amália Cínthia Meneses Rêgo
- UFRN, NatalRN, Brazil, Fellow PhD degree, Postgraduate Program in Health Sciences, UFRN, Natal-RN, Brazil. Acquisition and interpretation of data
| | - Marília Daniela Ferreira Carvalho
- UFRN, NatalRN, Brazil, Fellow PhD degree, Postgraduate Program in Health Sciences, UFRN, Natal-RN, Brazil. Acquisition and interpretation of data
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