Ileal tuberculosis causing hypercalcemia and renal failure

Abstract

Hypercalcemia rarely causes acute pancreatitis due to secretory block in the pancreas and damage by accumulated proteases. Hypercalcemia, though described in granulomatous disorders, is uncommon in tuberculosis. Acute kidney injury is known to occur with acute pancreatitis, secondary to sepsis and septic shock; however, acute pancreatitis resulting in acute cortical necrosis is very rare. We report a 22-year-old woman, who presented with pain abdomen and vomiting. She was found to have features of acute pancreatitis, both biochemically and radiologically. She had hypercalcemia on presentation and this was attributed to be the cause for pancreatitis as other causes were ruled out. 1, 25-dihydroxyvitamin D level was high with normal parathyroid hormone level. Whole-body positron emission tomography-computed tomography showed increased fluorodeoxyglucose uptake in the terminal ileum and histology from that area showed noncaseating granuloma with acid-fast bacilli in the tissue. She was treated with antituberculosis therapy; hypercalcemia improved over a period of time and pancreatitis resolved. She developed anuric renal failure, and kidney biopsy showed patchy acute cortical necrosis. She is dialysis dependent at the end of 6 months. To the best of our knowledge, this is the first case report of a patient with ileal tuberculosis presenting with hypercalcemia and acute pancreatitis. This case is reported due to the rarity of extrapulmonary tuberculosis presenting with symptomatic hypercalcemia, acute pancreatitis, and acute renal cortical necrosis.

Disseminated tuberculosis presented with explicit hypercalcemia: A clinical case report

“…Excess 1, 25-dihydroxy vitamin D3 levels from 25-dihydroxy vitamin D3 conversion (vitamin D dysregulation) are described as a diagnostic factor in most patients with TB-related hypercalcemia. 10 Hypercalcemia in granulomatous disorders can be difficult to diagnose. Keeping strong suspicion and being aware of the symptoms can help early detection and treatment.…”

“…About 2.3%–28% of the patients with TB, depending on the group of people being studied in different countries, manifest hypercalcemia. Excess 1, 25‐dihydroxy vitamin D3 levels from 25‐dihydroxy vitamin D3 conversion (vitamin D dysregulation) are described as a diagnostic factor in most patients with TB‐related hypercalcemia 10 . Hypercalcemia in granulomatous disorders can be difficult to diagnose.…”