{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T02:52:39Z","timestamp":1791168759825,"version":"4.1.0"},"reference-count":10,"publisher":"The Endocrine Society","issue":"11","funder":[{"DOI":"10.13039\/100016206","name":"UCLA Clinical and Translational Science Institute","doi-asserted-by":"publisher","award":["UL1TR001881)"],"award-info":[{"award-number":["UL1TR001881)"]}],"id":[{"id":"10.13039\/100016206","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We present the case of a 62-year-old woman with history of chronic kidney disease and birdshot retinochoroidopathy on immune suppression who presented with hypercalcemia, acute kidney injury, and Pneumocystis jirovecii pneumonia (PJP). Despite initial treatment with intravenous (IV) fluids, calcitonin, zoledronic acid, and antimicrobials for her pneumonia, her hypercalcemia persisted. Given her diagnosis of PJP and markedly elevated levels of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and vitamin A, prednisone (40\u2005mg\/day) and IV denosumab (120\u2005mg) were added to her regimen; however, there was no significant improvement in calcium levels. On hospital day 27, intermittent hemodialysis was initiated, resulting in a rapid correction of hypercalcemia, improved kidney function, and better volume status. The patient was discharged on prednisone with stable laboratory parameters.<\/jats:p>\n                  <jats:p>This case highlights the complex interplay of factors contributing to treatment-refractory hypercalcemia, including vitamin D toxicity, granulomatous infection-driven 1,25-dihydroxyvitamin D excess, and impaired renal clearance. It underscores the importance of early detection of supplement misuse, multidisciplinary care, and the potential need for hemodialysis when conventional treatments fail.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag306","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:26:25Z","timestamp":1789755985000},"source":"Crossref","is-referenced-by-count":0,"title":["Multifactorial causes of severe persistent hypercalcemia in an immunosuppressed woman with chronic kidney disease"],"prefix":"10.1210","volume":"4","author":[{"given":"Kavya","family":"Nalluri","sequence":"first","affiliation":[{"name":"Divisions of Endocrinology, Harbor-UCLA Medical Center and the Clinical and Translational Science Institute, the Lundquist Institute at Harbor-UCLA Medical Center , Torrance, CA 90502 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5229-1116","authenticated-orcid":false,"given":"Elizabeth L","family":"Goodman","sequence":"additional","affiliation":[{"name":"General Internal Medicine, Harbor-UCLA Medical Center and the Clinical and Translational Science Institute, the Lundquist Institute at Harbor-UCLA Medical Center , Torrance, CA 90502 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tejasvi","family":"Pasupneti","sequence":"additional","affiliation":[{"name":"General Internal Medicine, Harbor-UCLA Medical Center and the Clinical and Translational Science Institute, the Lundquist Institute at Harbor-UCLA Medical Center , Torrance, CA 90502 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Nunez","sequence":"additional","affiliation":[{"name":"General Internal Medicine, Harbor-UCLA Medical Center and the Clinical and Translational Science Institute, the Lundquist Institute at Harbor-UCLA Medical Center , Torrance, CA 90502 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8231-792X","authenticated-orcid":false,"given":"E Christina","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Harbor-UCLA Medical Center and the Clinical and Translational Science Institute, the Lundquist Institute at Harbor-UCLA Medical Center , Torrance, CA 90502 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"3","key":"2026100422265688600_luag306-B1","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/S0889-8529(18)30417-1","article-title":"Hypercalcemia","volume":"17","author":"Klee","year":"1988","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2026100422265688600_luag306-B2","first-page":"9","article-title":"Incidence of hypocalcemia and hypercalcemia in hospitalized patients: is it changing?","volume":"13","author":"Catalano","year":"2018","journal-title":"J Clin Transl Endocrinol"},{"issue":"3","key":"2026100422265688600_luag306-B3","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1210\/clinem\/dgac621","article-title":"Treatment of hypercalcemia of malignancy in adults: an endocrine society clinical practice guideline","volume":"108","author":"El-Hajj Fuleihan","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2026100422265688600_luag306-B4","doi-asserted-by":"crossref","first-page":"100011","DOI":"10.1016\/j.clinme.2023.100011","article-title":"Pneumocystis jirovecii pneumonia presenting with severe, refractory hypercalcaemia in an immunosuppressed renal transplant patient: review of the literature and novel biochemical insights","volume":"24","author":"Hong","year":"2024","journal-title":"Clin Med (Lond)"},{"issue":"4","key":"2026100422265688600_luag306-B5","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.ecl.2021.08.005","article-title":"Vitamin D-dependent hypercalcemia","volume":"50","author":"Schlingmann","year":"2021","journal-title":"Endocrinol Metab Clin North Am"},{"issue":"18","key":"2026100422265688600_luag306-B6","doi-asserted-by":"crossref","first-page":"10003","DOI":"10.3390\/ijms251810003","article-title":"Targeting calcitriol metabolism in acute vitamin D toxicity-A comprehensive review and clinical insight","volume":"25","author":"Aberger","year":"2024","journal-title":"Int J Mol Sci"},{"issue":"2","key":"2026100422265688600_luag306-B7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.3949\/ccjm.89a.21056","article-title":"Hypercalcemia and vitamin A: a vitamin to keep in mind","volume":"89","author":"Borgan","year":"2022","journal-title":"Cleve Clin J Med"},{"key":"2026100422265688600_luag306-B8","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.ajem.2021.11.013","article-title":"Severe hypercalcemia requiring acute hemodialysis: a retrospective cohort study with increased incidence during the COVID-19 pandemic","volume":"51","author":"Bentata","year":"2022","journal-title":"Am J Emerg Med"},{"issue":"1","key":"2026100422265688600_luag306-B9","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s40001-022-00715-x","article-title":"Fine-tuned continuous renal replacement therapy with calcium-free dialysate to manage severe hypercalcemia refractory to medical and intermittent hemodialysis","volume":"27","author":"Scheen","year":"2022","journal-title":"Eur J Med Res"},{"issue":"5","key":"2026100422265688600_luag306-B10","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1007\/s40620-022-01543-2","article-title":"Two cases of severe vitamin D(3) intoxication treated with therapeutic plasma exchange and high cut-off hemodialysis","volume":"36","author":"Heister","year":"2023","journal-title":"J Nephrol"}],"container-title":["JCEM Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/4\/11\/luag306\/71579347\/luag306.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/4\/11\/luag306\/71579347\/luag306.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T02:27:02Z","timestamp":1791167222000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcemcr\/article\/doi\/10.1210\/jcemcr\/luag306\/8860423"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":10,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,9,25]]}},"URL":"https:\/\/doi.org\/10.1210\/jcemcr\/luag306","relation":{},"ISSN":["2755-1520"],"issn-type":[{"value":"2755-1520","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,9,25]]},"article-number":"luag306"}}