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Successful management with bisphosphonate treatment in a child with tuberculosis-associated hypercalcemia
Suna Kilinc1, Ozlem Bostan2, Meltem Erol2
1Department of Pediatric Endocrinology, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey.
Insights
Severe hypercalcemia in children, though rare, can stem from granulomatous diseases like tuberculosis. This case highlights successful bisphosphonate treatment for hypercalcemia caused by miliary tuberculosis.
Area of Science:
- Pediatric Endocrinology
- Infectious Diseases
- Metabolic Disorders
Background:
- Hypercalcemia is a frequent metabolic issue in children, typically caused by hyperparathyroidism, vitamin D toxicity, genetic conditions, or malignancies.
- Granulomatous diseases are an uncommon etiology for pediatric hypercalcemia, often presenting mildly or asymptomatically.
Observation:
- This report details a pediatric case of severe hypercalcemia.
- The patient's condition was linked to miliary tuberculosis, a granulomatous disease.
Findings:
- The primary mechanism identified for hypercalcemia in this tuberculosis case was elevated synthesis of 1,25(OH)2D3 by activated macrophages within granuloma tissue.
- Successful management of severe hypercalcemia was achieved using bisphosphonate therapy.
Implications:
- This case underscores the importance of considering granulomatous diseases, particularly tuberculosis, in the differential diagnosis of pediatric hypercalcemia.
- Bisphosphonates represent an effective therapeutic option for managing severe hypercalcemia associated with miliary tuberculosis in children.
Abstract:
Hypercalcemia is a common metabolic abnormality in children and generally occurs due to hyperparathyroidism, vitamin D toxicity, some genetic disorders and malignant diseases. Granulomatous diseases are a rare cause of hypercalcemia in children, which are usually mild and asymptomatic. Severe hypercalcemia in granulomatous diseases has also been reported in the literature. Here, we report a child presenting with severe hypercalcemia secondary to miliary tuberculosis with successful management with bisphosphonate treatment. Increased 1,25(OH)2D3 synthesis by activated macrophages in the granuloma tissue is the major mechanism of hypercalcemia in tuberculosis.
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