Hypercalcaemia and hypokalaemia in tuberculosis

Area of Science:

• Endocrinology
• Pulmonology
• Nephrology

Background:

• Tuberculosis (TB) is a significant global health issue.
• Hypercalcemia and hypokalemia are electrolyte disturbances that can occur in various medical conditions.

Observation:

• Two patients with extensive pulmonary tuberculosis presented with hypercalcemia and hypokalemia.
• Hypercalcemia was linked to low-dose vitamin D supplementation, suggesting increased vitamin D sensitivity in TB patients.
• Kveim test was positive in both patients, indicating a potential similarity to sarcoidosis.

Findings:

• The hypercalcemia in these patients was rapidly resolved with corticosteroid therapy.
• Other causes of hypercalcemia, including hyperparathyroidism, thyrotoxicosis, Addison's disease, and multiple myeloma, were ruled out.
• Hypokalemia was characterized by increased renal potassium excretion, likely resulting from hypercalcemia-induced distal tubular damage.

Implications:

• This case series highlights a potential vitamin D hypersensitivity in patients with tuberculosis.
• The findings suggest that vitamin D supplementation should be approached with caution in TB patients.
• Corticosteroids may be an effective treatment for vitamin D-induced hypercalcemia in the context of tuberculosis.