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presenting as severe hypercalcemia
Mohammed Al-Homrany, Abdalla Sabeel, Tarek Malatani, Mahmoud Rabia, Nader Mourad, Abdulaziz Alassad
CaseRepClinPractRev 2002; 3(4):230-233
Background: Hypercalcemia in a dialysis patient may be caused by secondary hyperparathyroidism (SHPTH), adynamic bone disease (ABD), excessive use of calcium and Vit. D3 or granulomatous diseases. Tuberculosis (TB) is common among the dialysis population, however, the presentation is usually atypical and hence difficult to diagnose. The initial investigation of persistent hypercalcemia in dialysis patients is generally oriented towards
HPTH and the possibility of parathyroidectomy.
Case Report: A 65-year-old dialysis patient presented with hypercalcemia and confusion. Parathyroid nodules were detected and parathyriodectomy revealed a caseating granulomatous reaction consistent with tuberculosis.
Following parathyroidectomy and anti-TB treatment; the hypercalcemia resolved, other symptoms subsided and the patient recovered the well-being with significant gain of dry weight.
Conclusion: The patient presents a rare site of TB in the parathyroid glands causing severe hypercalcemia.