Severe hypercalcemia in a patient with pulmonary tuberculosis

Rajendra, Akhil; Mishra, Ajay Kumar; Francis, Nirmal Raj; Carey, Ronald Albert Benton

doi:10.4103/2249-4863.192327

Cited by 23 publications

(15 citation statements)

References 11 publications

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“…Biochemical results were consistent with previous reports of such cases of TB-induced hypercalcemia ( 6 , 7 ). In this particular context of TB-induced hypercalcemia, a first hypothesis for the Ca raise could be the high calcitriol concentrations, leading to an increased intestinal Ca absorption and osteoclastic bone resorption ( 3 – 5 ).…”

Section: Discussionsupporting

confidence: 93%

A rare case of tuberculosis-induced hypercalcemia

Wauthier

Theunssens

Durez

et al. 2020

Biochem. med. (Online)

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Laboratory investigations of hypercalcemia involve testing of various biochemical parameters such as parathyroid hormone (PTH), 25-(OH) Vitamin D (25-(OH) VitD), 1,25-(OH)2 Vitamin D3 (calcitriol) and PTH related peptide (PTHrp). We herein present an atypical case of severe hypercalcemia in a patient with rheumatoid arthritis who has been treated for years by various biological disease-modifying antirheumatic drugs (DMARDs) and suddenly presented with general state alteration, oedema and ulceration of her right ankle. We illustrate how tuberculosis (TB) can cause high calcitriol concentration and subsequently lead to potentially severe hypercalcemia. Moreover, we highlight the importance of TB testing and follow-up in patients treated with biological DMARDs.

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Section: Discussionsupporting

confidence: 93%

A rare case of tuberculosis-induced hypercalcemia

Wauthier

Theunssens

Durez

et al. 2020

Biochem. med. (Online)

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“…Severe hypercalcemia, although rare, is a manifestation of pulmonary tuberculosis. 12 In these cases, hypercalcemia is due to an over-abundance of extra-renal 1-alpha hydroxylase activity, which increases conversion of 1 vitamin D to 1,25-vitamin D, thus increasing calcium absorption in the gut. Inappropriate PTHrP production has been generally associated with malignancies, where it acts as the primary contributor of hypercalcemia and also has prognosis value in non-metastatic solid tumors.…”

Section: Discussionmentioning

confidence: 99%

A case of extrapulmonary tuberculosis in a patient with end-stage renal disease with elevated parathyroid hormone–related protein

Podder

Fleckenstein

Gaudiano

2020

SAGE Open Medical Case Reports

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The diagnosis of extrapulmonary tuberculosis in patients with end-stage renal disease can be challenging as the signs and symptoms are often non-specific. In this study, we present a case of extrapulmonary tuberculosis in an Ethiopian woman with end-stage renal disease who had subcarinal and right hilar lymphadenopathy, moderate sized right pleural effusion, hypercalcemia, and elevated parathyroid hormone–related protein in the setting of an elevated 1,25-dihydroxyvitamin D. After being started on appropriate tuberculosis treatment, patient’s parathyroid hormone–related protein level decreased and calcium level normalized. Our literature review showed that the elevation of parathyroid hormone–related protein in extrapulmonary tuberculosis has not been well studied, and it is our aim to explore the role of parathyroid hormone–related protein in extrapulmonary tuberculosis.

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“…Renal failure in those cases was attributed to renal vasoconstriction associated with hypercalcemia. [12]…”

Section: Discussionmentioning

confidence: 99%

Ileal tuberculosis causing hypercalcemia and renal failure

et al. 2019

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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.

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Severe hypercalcemia in a patient with pulmonary tuberculosis

Cited by 23 publications

References 11 publications

A rare case of tuberculosis-induced hypercalcemia

A rare case of tuberculosis-induced hypercalcemia

A case of extrapulmonary tuberculosis in a patient with end-stage renal disease with elevated parathyroid hormone–related protein

Ileal tuberculosis causing hypercalcemia and renal failure

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