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A rare case of tuberculosis-induced hypercalcemia
Loris Wauthier1, Xavier Theunssens2, Patrick Durez2,3
1Department of Clinical Biochemistry, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium.
Biochemia Medica
|August 11, 2020
Summary
Tuberculosis (TB) can cause severe hypercalcemia by increasing calcitriol levels, particularly in patients on biological disease-modifying antirheumatic drugs (DMARDs). Prompt TB testing is crucial for managing hypercalcemia in this patient group.
Area of Science:
- Endocrinology
- Rheumatology
- Infectious Diseases
Background:
- Laboratory investigations for hypercalcemia include parathyroid hormone (PTH), 25-(OH) Vitamin D, calcitriol, and PTH-related peptide (PTHrp).
- Biological disease-modifying antirheumatic drugs (DMARDs) are commonly used for rheumatoid arthritis management.
Observation:
- An atypical case of severe hypercalcemia presented in a rheumatoid arthritis patient undergoing long-term biological DMARD therapy.
- The patient exhibited general state alteration, edema, and right ankle ulceration.
Findings:
- Tuberculosis (TB) was identified as the cause of elevated calcitriol concentration, leading to severe hypercalcemia.
- This case highlights an unusual complication of TB in an immunocompromised patient on biological DMARDs.
Implications:
- Emphasizes the critical importance of tuberculosis screening and monitoring in patients receiving biological DMARDs.
- Suggests that elevated calcitriol levels in patients on biological DMARDs warrant thorough investigation for underlying infections like TB.
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