Hypercalcaemia and haemophagocytic syndrome: rare concurrent presentations of disseminated tuberculosis in a dialysis patient

Yc, Ko; Ct, Lee; Cheng, Yu‐Fan; Kh, Hung; Cy, Kuo; Cc, Huang; Jb, Chen

doi:10.1111/j.1368-5031.2004.00054.x

Cited by 14 publications

(11 citation statements)

References 18 publications

(15 reference statements)

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“…The reason may be that our site, located in southern part of Japan, has a low prevalence of sarcoidosis in general. Tuberculosis was shown to be an important cause of hypercalcemia in two Hong Kong studies (9,32), although the present study found no case of tuberculosis. Another reason for these variations may be the time of data collection, since the incidence of granulomatous diseases may fluctuate over time (33).…”

Section: The Major Causes Of Hypercalcemia Were Found To Be Malignanccontrasting

confidence: 52%

The Causes of Hypercalcemia in Okinawan Patients: AnInternational Comparison

2007

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Section: The Major Causes Of Hypercalcemia Were Found To Be Malignanccontrasting

confidence: 52%

The Causes of Hypercalcemia in Okinawan Patients: AnInternational Comparison

2007

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“…The most common forms of presentation are lymphadenitis, gastrointestinal, bone, genitourinary, peritonitis, pleural effusion, pericardial effusion, miliary TB, and pyrexia of unknown origin (7)(8)(9)(10). On the other hand, uremia is commonly associated with fatigue, malnutrition, and other nonspecific complaints, possibly concealing the course of an underlying TB disease (7,11,12).…”

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confidence: 99%

Diagnosis of Tuberculosis in Dialysis Patients

Segall

Covic²

2010

Clinical Journal of the American Society of Nephrology

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Patients with ESRD undergoing chronic dialysis are much more prone to develop tuberculosis (TB) than the general population. In these patients, the diagnosis of TB disease is often difficult because of prevailing extrapulmonary involvement and nonspecific symptoms. The prevalence of latent TB infection (LTBI) in ESRD patients is elevated, and those who become infected are at high risk of developing active disease. Therefore, screening for LTBI in this population is recommended, aiming to prevent progression to active TB and secondary contamination of others. The tuberculin skin test (TST), the classic diagnostic tool for LTBI, has several major drawbacks, including poor sensitivity (because of a high prevalence of anergy in dialysis patients) and specificity [with false-positive tests in those vaccinated with bacille Calmette-Guérin (BCG)]. In the past 10 years or so, new immunological tests using IFN-␥ release assays (IGRAs) have become available and have shown superior sensitivity and specificity for the diagnosis of TB compared with the TST in several studies, some very recent ones including ESRD patients. Therefore, current strategy in dialysis patients should use these tests instead of TST for LTBI screening and as an aid for the diagnosis of active TB.

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“…In several studies, TST positivity was found to be between 11% and 68% according to the region and center of study, patient characteristics, and the admission limit of positive test. 18,23,[31][32][33] In a prospective study of 200 renal transplanted patients, Agarwal et al 34 reported that the risk of developing TB was found to be similar in patients with positive and negative TST and suggested that TST was not specific and sensitive in the diagnosis of TB. HD patients are more often exposed to the hospital environment and are usually older compared with the PD patients.…”

Section: Discussionmentioning

confidence: 99%

“…In dialysis patients, TB diagnosis is more complex and difficult because of an increased frequency of extrapulmonary involvement, atypical presentation, and non-specific symptoms and findings. 13,[16][17][18][19][20][21][22][23] Tuberculin skin test (TST) has high false-negative rates in patients with end-stage renal disease. 1,3,6 Anergy in the general population is below 5% but in CRF patients it is between 32% and 40%.…”

Section: Introductionmentioning

confidence: 99%

The Affecting Factors and Comparison of Tuberculin Skin Test in Peritoneal Dialysis and Hemodialysis Patients

et al. 2012

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Compared with the general population, patients with chronic renal failure have increased tuberculosis (TB) prevalence and mortality rates. In this study, we aimed to investigate tuberculin skin test (TST) positivity rates in hemodialysis (HD) and peritoneal dialysis (PD) patients and the factors influencing TST positivity. Ninety-two HD patients and 44 PD patients who had been on HD and PD treatment for at least 3 months were recruited into the study. TST was administered in all patients. Positivity was defined as an induration diameter >10 mm. At least 5 mm of induration following skin testing together with a chest radiography indicating previous infection was defined as latent TB infection. TST positivity rates, diameter of TST indurations, and serum albumin levels in HD patients were higher than the PD patients. TST induration size was not correlated with any other parameters in both HD and PD groups. TST-positive patients had higher albumin levels and lower leukocyte count than the TST-negative patients. In TST-positive patients, albumin level was correlated with the duration of dialysis but TST induration size was not correlated with the lymphocyte count and albumin level. In our study, TST positivity of patients was found in 30.4% of HD patients, 9% of PD patients, and 23.5% of total patients. It is still recommended to use TST for the screening test of TB. We found a significant relationship between TST and albumin level. It should be remembered that TST response may be lower in PD patients, especially in cases in which TB is suspected.

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Hypercalcaemia and haemophagocytic syndrome: rare concurrent presentations of disseminated tuberculosis in a dialysis patient

Cited by 14 publications

References 18 publications

The Causes of Hypercalcemia in Okinawan Patients: AnInternational Comparison

The Causes of Hypercalcemia in Okinawan Patients: AnInternational Comparison

Diagnosis of Tuberculosis in Dialysis Patients

The Affecting Factors and Comparison of Tuberculin Skin Test in Peritoneal Dialysis and Hemodialysis Patients

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