Respiratory failure and symptomatic hypercalcaemia complicating pulmonary tuberculosis

A 47-year-old Caucasian man was admitted to hospital with respiratory failure due to a severe pneumonia, requiring admission to the Intensive Care Unit (ICU) for respiratory support. Bronchial washings cultured Mycobacterium tuberculosis, a rare cause of respiratory failure, and fortunately he responded to standard antituberculous therapy. However, the patient subsequently developed symptomatic hypercalcaemia; an unusual complication of tuberculosis (TB) in the UK, probably contributed to by a combination of sunbathing and activation of 25-hydroxy vitamin D in the TB granuloma. The majority of patients treated for TB in the UK are probably vitamin D deficient and are therefore unlikely to become hypercalcaemic.