alexa Fluconazole-Associated Hypercalcemia in Patients with Coccidioidomycosis | OMICS International | Abstract
ISSN: 2165-7920

Journal of Clinical Case Reports
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Case Report

Fluconazole-Associated Hypercalcemia in Patients with Coccidioidomycosis

Nam H Chan1, Janis E Blair3, Sydney A Westphal2, Leila K Tehrani4 and Maria Teresa A Seville3*

1Division of Community Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona, USA

2Division of Endocrinology, Mayo Clinic Hospital, Phoenix, Arizona, USA

3Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA

4Division of Pharmacy, Mayo Clinic Hospital, Phoenix, Arizona, USA

*Corresponding Author:
Maria Teresa A Seville
Division of Infectious Diseases
Mayo Clinic Hospital, Phoenix
Arizona, USA
Tel: +1 480-515-6296
E-mail: [email protected]

Received date: March 28, 2016; Accepted date: May 12, 2016; Published date: May 19, 2016

Citation: Chan NH, Blair JE, Westphal SA, Tehrani LK, Seville MTA (2016) Fluconazole-Associated Hypercalcemia in Patients with Coccidioidomycosis. J Clin Case Rep 6: 800. doi:10.4172/2165-7920.1000800

Copyright: © 2016 Chan NH et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Abstract

Fluconazole, voriconazole, and itraconazole may potentiate the hypercalcemic effect of other medications, although to date, triazoles alone have not been linked to hypercalcemia. We describe a case of new-onset hypercalcemia in the setting of high-dose fluconazole that resolved after changing the antifungal regimen. We reviewed our institutional database to assess the frequency of moderate or severe hypercalcemia (serum calcium ≥12 mg/dL) among patients with coccidioidomycosis treated with a triazole. We identified 2,133 patients, seen from January 1, 2005, through December 20, 2012, with a diagnosis of coccidioidomycosis. Twenty-three patients (1%) had subsequent hypercalcemia; of these, 20 patients (87%) had moderate or severe hypercalcemia. Nine of the 20 patients (45%) with moderate or severe hypercalcemia were taking triazoles, and most had comorbid conditions that were risk factors for hypercalcemia (tertiary hyperparathyroidism, n=4; multiple myeloma, n=2; adrenal insufficiency, n=1). The effect of fluconazole on calcium metabolism possibly is small or not clinically significant until the dose is high. Fluconazole may also contribute to hypercalcemia in patients with underlying hyperparathyroidism because of the loss of calcium’s inhibitory effect on parathyroid hormone secretion. In summary, moderate or severe hypercalcemia is uncommon in coccidioidomycosis and rare in those treated with triazoles. High-dose fluconazole may be associated with symptomatic hypercalcemia, especially in patients with predisposing comorbid conditions.

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