Tuberculosis and hypercalcemia.

J M Santos, P Monteiro, A Fortes, E Silva, M A Barbosa, A G da Palma-Carlos


The authors present a case of disseminated tuberculosis in a patient under dialysis with endstage renal disease. Fever, nocturnal sweating, anorexia, asthenia, ascites, lymph node involvement and granulomatous involvement of the bone marrow were observed. In the twenty nine months of renal failure which preceded the beginning of the tuberculosis, serum calcium levels were normal or low-normal and there was a secondary hyperparathyroidism. During that period the patient was treated with calcium carbonate and calcitriol. At the onset of tuberculosis, serum calcium levels rose above normal. Treatment with calcium and calcitriol was withdrawn but hypercalcemia remained unchanged. Serum concentration of parathormone fell significantly. Antituberculosis drugs were started. The resolution of active tuberculosis was accompanied by normalization of serum calcium levels and by elevation above normal of serum concentration of parathormone.

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