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Hypercalcemia in Human Immunodeficiency Virus-Related Lymphoma and Valacyclovir Toxicity
LETTER
TO THE
Hypercalcemia in Human Immunodeficiency Virus-Related Lymphoma and Valacyclovir Toxicity To the Editor: e thank Shrayyef et al for their article entitled “Hypercalcemia in Two Patients with Sarcoidosis and Mycobacterium avium intracellulare Not Mediated by Elevated Vitamin D Metabolites,”1 which was published in the October issue of The American Journal of the Medical Sciences (Vol. 342, 4, pp 336 –340). The authors wrote very excellent review on granulomatous diseases induced by hypercalcemia without elevated active vitamin D level. We found an interesting association between human immunodeficiency virus (HIV) infection, valacyclovir and hypercalcemia in the first case study. Hypercalcemiarelated granulomatous diseases and non-Hodgkin lymphomas are not uncommon in HIV-infected patients especially in patients with low CD4 counts, high HIV viral loads and a prior diagnosis of AIDS.2 In addition, Li et al3 recently reported a case of severe hypercalcemia due to valacyclovir toxicity. The dose of valacyclovir should be renally adjusted
EDITOR
for kidney function, and physicians should be aware of the possibility of valacyclovir-induced hypercalcemia as in the first case presentation.
Wisit Cheungpasitporn, MD Promporn Suksaranjit, MD Sirisak Chanprasert, MD Department of Internal Medicine Bassett Medical Center Cooperstown, New York [email protected]
W
REFERENCES 1. Shrayyef MZ, Depapp Z, Cave WT, et al. Hypercalcemia in two patients with sarcoidosis and Mycobacterium avium intracellulare not mediated by elevated vitamin D metabolites. Am J Med Sci 2011 342:336 – 40. 2. Engels EA, Pfeiffer RM, Landgren O, et al. Immunologic and virologic predictors of AIDS-related non-hodgkin lymphoma in the highly active antiretroviral therapy era. J Acquir Immune Defic Syndr 2010;54: 78 – 84. 3. Li A, Shah JN, Mandayam S. Hypercalcemia due to valacyclovir toxicity. Am J Kidney Dis 2011;57:B59.
The American Journal of the Medical Sciences • Volume 342, Number 6, December 2011
539
TO THE
Hypercalcemia in Human Immunodeficiency Virus-Related Lymphoma and Valacyclovir Toxicity To the Editor: e thank Shrayyef et al for their article entitled “Hypercalcemia in Two Patients with Sarcoidosis and Mycobacterium avium intracellulare Not Mediated by Elevated Vitamin D Metabolites,”1 which was published in the October issue of The American Journal of the Medical Sciences (Vol. 342, 4, pp 336 –340). The authors wrote very excellent review on granulomatous diseases induced by hypercalcemia without elevated active vitamin D level. We found an interesting association between human immunodeficiency virus (HIV) infection, valacyclovir and hypercalcemia in the first case study. Hypercalcemiarelated granulomatous diseases and non-Hodgkin lymphomas are not uncommon in HIV-infected patients especially in patients with low CD4 counts, high HIV viral loads and a prior diagnosis of AIDS.2 In addition, Li et al3 recently reported a case of severe hypercalcemia due to valacyclovir toxicity. The dose of valacyclovir should be renally adjusted
EDITOR
for kidney function, and physicians should be aware of the possibility of valacyclovir-induced hypercalcemia as in the first case presentation.
Wisit Cheungpasitporn, MD Promporn Suksaranjit, MD Sirisak Chanprasert, MD Department of Internal Medicine Bassett Medical Center Cooperstown, New York [email protected]
W
REFERENCES 1. Shrayyef MZ, Depapp Z, Cave WT, et al. Hypercalcemia in two patients with sarcoidosis and Mycobacterium avium intracellulare not mediated by elevated vitamin D metabolites. Am J Med Sci 2011 342:336 – 40. 2. Engels EA, Pfeiffer RM, Landgren O, et al. Immunologic and virologic predictors of AIDS-related non-hodgkin lymphoma in the highly active antiretroviral therapy era. J Acquir Immune Defic Syndr 2010;54: 78 – 84. 3. Li A, Shah JN, Mandayam S. Hypercalcemia due to valacyclovir toxicity. Am J Kidney Dis 2011;57:B59.
The American Journal of the Medical Sciences • Volume 342, Number 6, December 2011
539