Asymptomatic hypercalcemia due to cavitary pulmonary tuberculosis: A case report

Abstract

Hypercalcemia in granulomatous diseases as tuberculosis (TB) is uncommon. We describe a case of a 21-year-old male whose serum calcium level was 14 mg/dL at the time of admission. Chest imaging revealed a cavity at the top of both lungs as well as the closure of the right laberal angle. The sputum smears and culture were evaluated regarding Mycobacterium tuberculosis and the findings of the smear and culture were reported as positive. As the values of creatinine were increased, renal failure had to be investigated. Both pathological mechanisms appear to affect the renal function. The anti-TB treatment included isoniazid 5 mg/kg, rifampicin 10 mg/kg and pyrazinamide 20 mg/kg once daily for two months and then the therapy continued with isoniazid and pyrazinamide up to eight months. The patient also received hydration, loop diuretics, and prednisolone (20 mg per day). One week after the introduction of the corticosteroid therapy, the patient's serum creatinine and calcium (Ca) levels decreased (4 mg/dL to 2 mg/dL, and 14 mg/dL to 10 mg/dL, respectively). Hypercalcemia, renal failure, interstitial nephritis, and proteinuria are rare in pulmonary tuberculosis but should be considered as severe complications. Therefore, hypercalcemia should be first controlled by hydration or some steroids along with the treatment of TB, and introduction of loop diuretics and nutritional constraints.