Chronic hypercalcemia as the presenting feature of tuberculous peritonitis in a hemodialysis patient

Hypercalcemia is a common electrolyte disturbance in chronic dialysis patients. Although most causes are easily identified, some are obscure. Tuberculosis, a granulomatous disease associated with hypercalcemia, can appear at anytime while the infection is active. Dialysis-associated tuberculosis is characterized by a higher risk than that in the general population, with a greater chance of extrapulmonary involvement and a high mortality rate. If the presentation of tuberculosis is atypical and its manifestation nonspecific, diagnosis can be delayed, leading to poor patient outcome. Herein, we report a case of tuberculous peritonitis in a hemodialysis patient. Asymptomatic hypercalcemia was noted 8 months before ascites became detectable. Nevertheless, the patient responded well to antituberculous therapy. We conclude that hypercalcemia can be an early sign of tuberculous peritonitis in the absence of other signs and symptoms. Remaining aware of the possibility of tuberculosis and testing for it, physicians can identify tuberculous infection earlier and initiate appropriate therapy in a timely manner.