Pneumocystis pneumonia (PCP) is a life-threatening fungal infection occurring in immunocompromised patients such as HIV-positive patients with low CD4 cell count or patients under heavy immunosuppressive therapy. We report the case of a 59-year-old male with severe diffuse cutaneous systemic sclerosis presenting with asthenia, dry cough and worsening shortness of breath for the last 15 days. Biological studies were remarkable for PTH-independent severe hypercalcemia with low 25-hydroxyvitamin D and a paradoxically elevated 1,25-dihydroxyvitamin D. Early bronchoalveolar lavage allowed for PCP diagnosis and targeted treatment. We discuss the underlying physiopathology and difficulties regarding prophylaxis and treatment.

中文翻译：

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高钙血症预示着患有弥漫性皮肤系统性硬化症的 HIV 血清阴性患者的肺囊虫肺炎

肺孢子菌肺炎 (PCP) 是一种危及生命的真菌感染，发生在免疫功能低下的患者中，例如 CD4 细胞计数低的 HIV 阳性患者或接受大量免疫抑制治疗的患者。我们报告了一例患有严重弥漫性皮肤系统性硬化症的 59 岁男性，在过去 15 天内表现为虚弱、干咳和呼吸急促恶化。对于 PTH 非依赖性严重高钙血症，25-羟基维生素 D 低和 1,25-二羟基维生素 D 异常升高，生物学研究非常显着。早期支气管肺泡灌洗可用于 PCP 诊断和靶向治疗。我们讨论了有关预防和治疗的潜在病理生理学和困难。