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Hypercalcemia in a patient with tuberculous mediastinal lymphadenopathy
T T Tan1, B C Lee, B M Zainuddin
1Department of Medicine, University Kebangsaan Malaysia, Kuala Lumpur.
Insights
Tuberculosis can cause hypercalcemia, a condition of high blood calcium. This case study shows that treating tuberculosis effectively resolves hypercalcemia, highlighting the importance of considering this link in diagnosis.
Area of Science:
- Internal Medicine
- Pulmonology
- Endocrinology
Background:
- Hypercalcemia, a condition characterized by elevated serum calcium levels, can manifest with diverse symptoms and etiologies.
- Tuberculosis (TB), a significant global infectious disease, has been anecdotally linked to hypercalcemia, particularly in Western populations.
- Limited local data exists regarding the prevalence and management of hypercalcemia associated with tuberculosis in Indian patients.
Purpose of the Study:
- To report a case of hypercalcemia secondary to tuberculosis in a 48-year-old Indian female.
- To highlight the diagnostic approach and successful management of this rare clinical presentation.
- To contribute to the understanding of tuberculosis-associated hypercalcemia in a local context.
Main Methods:
- Clinical presentation review of a patient with hypercalcemia symptoms.
- Diagnostic imaging including chest radiography to assess for pulmonary abnormalities.
- Histopathological examination of enlarged hilar lymph nodes for tuberculosis confirmation.
- Monitoring of serum calcium levels during anti-tuberculous therapy.
Main Results:
- The patient presented with symptoms consistent with hypercalcemia.
- Chest radiographs revealed bilateral hilar lymphadenopathy with normal lung fields.
- Histological analysis of hilar lymph node biopsy confirmed tuberculosis.
- Hypercalcemia resolved completely after one month of anti-tuberculous treatment.
Conclusions:
- Tuberculosis should be considered in the differential diagnosis of hypercalcemia, even in the absence of typical pulmonary findings.
- Effective anti-tuberculous treatment is crucial for resolving hypercalcemia of this etiology.
- Further local studies are warranted to elucidate the prevalence and underlying mechanisms of tuberculosis-associated hypercalcemia.
Abstract:
We describe the case of a 48 year old Indian female with hypercalcemia due to tuberculosis. She presented with symptoms of hypercalcemia and chest radiographs showed bilateral hilar lymphadenopathy with normal lung fields. The diagnosis of tuberculosis was made histologically from biopsy of the enlarged hilar nodes. Her hypercalcemia resolved following one month of anti-tuberculous treatment. The prevalence of hypercalcemia in tuberculosis has been reported to be high in western series. There is, however, a paucity of local data on the subject. The presence of 1-alpha-hydroxylase-like activity in pulmonary alveolar macrophages with resulting increased formation of active vitamin D metabolites is the postulated mechanism of tuberculosis associated hypercalcemia.