{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:10:02Z","timestamp":1756318202568,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,11,16]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>We report an elderly man who presented with giddiness and right-sided weakness, constipation and constitutional symptoms for 6 months duration. Blood investigations indicated hypercalcaemia with normal serum phosphate and acute kidney injury. Serum intact parathyroid hormone was suppressed. CT revealed bilateral tiny lung nodules with right upper lobe tree in bud appearance and incidental findings of bilateral adrenal lesion. Tuberculosis was ruled out. CT adrenal showed multiseptated hypodense rim enhancement adrenal lesion bilaterally. Adrenal function tests were normal except for low dehydroepiandrosterone (DHEA). Right-sided cervical lymph node biopsy confirmed fungal infection with the presence of intracellular and extracellular fungal yeast. Serum cryptococcus antigen titre was positive. Our final diagnosis was disseminated cryptococcosis with lungs, bilateral adrenal gland and lymph nodes involvement. The patient was then treated with antifungal treatment. Serum calcium was normalised after 1\u2009month with marked clinical improvement.<\/jats:p>","DOI":"10.1136\/bcr-2021-245025","type":"journal-article","created":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T11:50:24Z","timestamp":1638964224000},"page":"e245025","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Hypercalcaemia associated with disseminated cryptococcosis"],"prefix":"10.1136","volume":"14","author":[{"given":"Hazwani","family":"Aziz","sequence":"first","affiliation":[{"name":"Department of Internal Medicine\/ Endocrinology, Hospital Tuanku Ja'afar Seremban, Seremban, Negeri Sembilan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noor Lita","family":"Adam","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\/ Endocrinology, Hospital Tuanku Ja'afar Seremban, Seremban, Negeri Sembilan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nor Afidah","family":"Karim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\/ Endocrinology, Hospital Tuanku Ja'afar Seremban, Seremban, Negeri Sembilan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,12,8]]},"reference":[{"key":"2025082710345436000_14.12.e245025.1","doi-asserted-by":"crossref","first-page":"S51","DOI":"10.1002\/jbmr.5650061413","article-title":"Differential diagnosis of hypercalcemia","volume":"6 Suppl 2","author":"Lafferty","year":"1991","journal-title":"J Bone Miner Res"},{"key":"2025082710345436000_14.12.e245025.2","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1093\/ndt\/gfy054","article-title":"Hypercalcemia: etiology and management","volume":"33","author":"Renaghan","year":"2018","journal-title":"Nephrology Dialysis Transplantation"},{"key":"2025082710345436000_14.12.e245025.3","unstructured":"Shane E , Dinaz I . Hypercalcemia: pathogenesis, clinical manifestations, differential diagnosis, and management. In: Favus MJ , ed. Primer on the metabolic bone diseases and disorders of mineral metabolism. 6th edn. Washington, DC: American Society for Bone and Mineral Research, 2006: 176\u201380."},{"key":"2025082710345436000_14.12.e245025.4","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1056\/NEJMcp042806","article-title":"Hypercalcemia associated with cancer","volume":"352","author":"Stewart","year":"2005","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082710345436000_14.12.e245025.5","first-page":"77","article-title":"Parathyroid disorders. focusing on unmet needs","volume":"51","author":"Brandi","year":"2019","journal-title":"Front Horm Res. 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