Hypercalcaemia in an immunocompromised patient: consider Pneumocystis jirovecii pneumonia

A 71‐year‐old man with a history of 6 weeks of generalised decline presented for outpatient clinic assessment. Initial symptoms included fatigue, weakness, and anorexia causing 6 kg weight loss. His medical history was significant for a live‐related renal transplant 20 years earlier for membranous glomerulonephritis, insulin‐dependent type 2 diabetes mellitus, a right native nephrectomy 12‐months prior for clear cell renal cell carcinoma (Grade 3, pT1a), and multiple basal and squamous cell carcinomas of the skin. Maintenance immunosuppression was with mycophenolate mofetil 1 g twice a day and cyclosporine 50 mg twice a day without prednisolone. He had received one infusion of rituximab 800 mg 4 months earlier for biopsy‐proven recurrent membranous glomerulonephritis. Further history and examination did not reveal any localising symptoms or signs.