Severe Hypokalemia as a Rare Presentation of Disseminated Tuberculosis

Disseminated tuberculosis (TB) is a mycobacterial infection in which the mycobacteria have spread from the lungs to other parts of the body through the blood or lymph system. We report a 38-year-old patient who presented with fever and severe weakness for five days. His initial workup in the emergency room showed severe hypokalemia resistant to multiple doses of potassium replacement. The patient later showed features of meningitis. His cerebrospinal fluid analysis confirmed tuberculous meningitis. After starting on anti-tuberculous medications, his hypokalemia improved significantly. Sputum culture was positive for TB, and the patient labeled as disseminated TB. Despite severe hypokalemia being a rare association with TB, disseminated TB can be considered the possible cause in patients presenting with severe hypokalemia and fever. Renal tubular defect could be the proposed mechanism causing potassium losing nephropathy.