RESUMO
Background: Tuberculosis (TB) is prevalent worldwide and causes significant morbidity and mortality. TB is known to cause hypercalcemia. We aimed to assess the prevalence and risk factors for developing hypercalcemia among patients with TB. Methods: In this retrospective case-control study, patients with microbiological evidence of TB and an available serum calcium value were included between 2005 and 2016. The demographic, clinical, and laboratory details were recorded. Various risk factors were compared in TB patients with and without hypercalcemia. Results: A total of 129 patients fulfilled the inclusion criteria. Twenty percent were found to have an elevated serum calcium level, 65% of them had clinical features of hypercalcemia. In comparison, the odds of developing hypercalcemia in the presence of disseminated TB, diabetes and renal failure was 1.83, 1.60, and 7.33, respectively. Conclusion: One-fifth of patients with TB have hypercalcemia. Risk factors of the same are renal failure, diabetes, and disseminated TB.
Assuntos
Hipercalcemia/epidemiologia , Hipercalcemia/etiologia , Tuberculose Miliar/complicações , Adulto , Estudos de Casos e Controles , Complicações do Diabetes , Diabetes Mellitus , Feminino , Humanos , Hipercalcemia/microbiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal/complicações , Estudos Retrospectivos , Fatores de Risco , Tuberculose Miliar/sangueRESUMO
The incidence and prevalence of nontuberculous mycobacteria (NTM) infection is on the rise with many cases still going unreported. Given the vague and nonspecific clinical features of NTM infections, it is often missed or mistaken for Mycobacterium tuberculosis. The presumption that NTM infections are benign and do not contribute to morbidity no longer holds true. NTM infections need to be considered in patients with disseminated multisystem disease and in those not responding to standard M. tuberculosis treatment. As NTM infection is associated with granuloma formation, it can result in hypercalcaemia. Interestingly, there is evidence that there may be other mechanisms in play contributing to hypercalcaemia besides the increased calcitriol levels.
Assuntos
Hipercalcemia/microbiologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium abscessus , Mycobacterium fortuitum , Idoso , Antibacterianos/uso terapêutico , Anticorpos/sangue , Cefoxitina/uso terapêutico , Ciprofloxacina/uso terapêutico , Claritromicina/uso terapêutico , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Feminino , Granuloma/patologia , Humanos , Interferons/imunologia , Fígado/patologia , Fator Estimulador de Colônias de Macrófagos/imunologia , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , SingapuraRESUMO
Vitamin D-mediated hypercalcemia is an uncommon complication of Pneumocystis infection. A granulomatous response resulting from Pneumocystis infection is also atypical. In this report, we describe an exceptional case of granulomatous Pneumocystis pneumonia associated with vitamin D-mediated hypercalcemia, in a patient who presented unusually late after renal transplantation. The patient's hypercalcemia resolved with treatment of the infection.
Assuntos
Granuloma/microbiologia , Hipercalcemia/diagnóstico , Transplante de Rim , Pneumonia por Pneumocystis/diagnóstico , Vitamina D/efeitos adversos , Injúria Renal Aguda/etiologia , Antifúngicos/uso terapêutico , Clindamicina/uso terapêutico , Granuloma/tratamento farmacológico , Humanos , Hipercalcemia/microbiologia , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii , Pneumonia por Pneumocystis/tratamento farmacológico , Primaquina/uso terapêutico , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: A 5-year old hunting dog was presented with reduced appetite, weight loss and polyuria/polydipsia. Hematology and clinical chemistry revealed anemia, leukocytosis, increased liver enzymes, hypoalbuminemia and hypercalcemia. The cytological, pathohistological and microbiological examination identified a disseminated infection with the saprophytic mould fungus Paecilomyces variotii in the biopsies of the spleen and a lymph node. Determination of vitamin D metabolites confirmed a calcitriol induced hypercalcemia.
Assuntos
Calcitriol/sangue , Doenças do Cão/sangue , Doenças do Cão/microbiologia , Hipercalcemia/veterinária , Micoses/veterinária , Paecilomyces/isolamento & purificação , Animais , Cães , Hipercalcemia/sangue , Hipercalcemia/microbiologia , Micoses/sangue , Micoses/microbiologiaRESUMO
Hypercalcaemia occurs in many granulomatous diseases. Among them, sarcoidosis and tuberculosis are the most common causes. Other causes include berylliosis, coccidioidomycosis, histoplasmosis, Crohn's disease, silicone-induced granulomas, cat-scratch disease, Wegener's granulomatosis and Pneumocystis carinii pneumonia. Hypercalcaemia in granulomatous disease occurs as a consequence of dysregulated production of 1,25-(OH)2 D3 (calcitriol) by activated macrophages in granulomas. Hypercalcaemia in patients with Mycobacterium tuberculosis infection has been reported in 0%-28% of cases. Uncultured bronchoalveolar lavage cells from patients with M. tuberculosis produce greater amounts of calcitriol compared with controls. Although Nayar et al described hypercalcaemia in a case of sepsis associated with intravesical Bacille Calmette Guerin therapy, there are no published reports describing hypercalcaemia in patients with pulmonary M. bovis infection. We describe a patient with M. bovis cavitary pulmonary infection with sustained hypercalcaemia that fluctuated and recurred repeatedly over the course of therapy, ultimately culminating in normalisation of serum calcium when therapy had led to cure. Treatment consisted of antituberculous therapy, oral corticosteroids and intravenous bisphosphonates with a favourable outcome.
Assuntos
Calcitriol/sangue , Hipercalcemia/microbiologia , Mycobacterium bovis , Tuberculose Pulmonar/complicações , Antituberculosos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/microbiologiaRESUMO
Many diseases can cause hypercalcaemia, including primary hyperparathyroidism, cancer, drugs and granulomatous diseases. A nursing home resident aged 81 years was admitted because of altered mental status. The patient did not have fever, cough, sputum or night sweat. Hypercalcaemia was identified as a cause of the consciousness disturbance. Chest radiograph showed no acute process. Laboratory workups revealed elevated serum levels of 1,25-(OH)2 vitamin D3 and positive T-spot test. Microscopic examination of the suctioned sputum identified acid-fast bacilli, which was confirmed as Mycobactrium tuberculsosis Tuberculosis should be considered as the important cause of hypercalcaemia since early diagnosis and treatment is recommended for preventing its outbreak among people with close contacts with patients.
Assuntos
Hipercalcemia/microbiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Infecções Assintomáticas , Humanos , Hipercalcemia/complicações , Masculino , Transtornos Mentais/etiologia , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
Abstract A 37-year-old man with AIDS presented with altered mental status four weeks after stopping his medications for Mycobacterium avium-intracellulare (MAI). He had low CD4 cell count and severe hypercalcemia. Bone marrow biopsy revealed bone marrow infiltration by granulomas positive for acid-fast bacilli and cultures grew MAI. His hypercalcemia continued to worsen with the initiation of MAI therapy but we were able to treat it successfully with pamidronate and calcitonin.
Assuntos
Humanos , Masculino , Adulto , Infecção por Mycobacterium avium-intracellulare/complicações , Infecções Oportunistas Relacionadas com a AIDS/complicações , Hipercalcemia/microbiologia , Hipercalcemia/diagnóstico por imagem , Medula Óssea/microbiologia , Medula Óssea/patologia , Imageamento por Ressonância Magnética , Complexo Mycobacterium avium/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Contagem de Linfócito CD4 , Hipercalcemia/tratamento farmacológicoRESUMO
A 37-year-old man with AIDS presented with altered mental status four weeks after stopping his medications for Mycobacterium avium-intracellulare (MAI). He had low CD4 cell count and severe hypercalcemia. Bone marrow biopsy revealed bone marrow infiltration by granulomas positive for acid-fast bacilli and cultures grew MAI. His hypercalcemia continued to worsen with the initiation of MAI therapy but we were able to treat it successfully with pamidronate and calcitonin.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Hipercalcemia/diagnóstico por imagem , Hipercalcemia/microbiologia , Infecção por Mycobacterium avium-intracellulare/complicações , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Medula Óssea/microbiologia , Medula Óssea/patologia , Contagem de Linfócito CD4 , Humanos , Hipercalcemia/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Complexo Mycobacterium avium/isolamento & purificaçãoAssuntos
Hipercalcemia/microbiologia , Doenças Testiculares/diagnóstico , Tuberculose/diagnóstico , Injúria Renal Aguda/etiologia , Erros de Diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Doenças Testiculares/complicações , Doenças Testiculares/tratamento farmacológico , Tuberculose/complicações , Tuberculose/tratamento farmacológicoAssuntos
Hipercalcemia/microbiologia , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/diagnóstico , Idoso , Tosse/microbiologia , Dispneia/microbiologia , Humanos , Falência Renal Crônica/cirurgia , Transplante de Rim , Masculino , Pneumonia por Pneumocystis/tratamento farmacológicoRESUMO
The authors present a puzzling case of nephrolithiasis, hypercalcaemia, amenorrhoea, short stature and gross skeletal deformities in a 30-year-old female. Multiple pituitary hormone deficiency and metabolic bone disease were initially considered but were eventually excluded. The final diagnosis is genitourinary tuberculosis (TB) which caused the hypercalcaemia, nephrolithiasis and amenorrhoea, and also found to have the syndrome of multiple exostoses which explained the gross skeletal deformities and the short stature. After treatment with anti-TB therapy, there was resolution of hypercalcaemia and return of regular menstruation. The short stature and gross skeletal deformities remain as part of the congenital syndrome.
Assuntos
Amenorreia/microbiologia , Exostose Múltipla Hereditária/diagnóstico , Hipercalcemia/microbiologia , Nefrolitíase/etiologia , Tuberculose dos Genitais Femininos/diagnóstico , Adulto , Diagnóstico Diferencial , Exostose Múltipla Hereditária/complicações , Feminino , Humanos , Hipercalcemia/diagnóstico , Nefrolitíase/diagnóstico , Tuberculose dos Genitais Femininos/complicaçõesRESUMO
A 44-year-old woman who had recently been on immunosuppressive therapy presented with malaise, cough, fever, weight loss, lymphadenopathy, severe hypercalcaemia and a paratracheal mass on imaging. The initial impression was of disseminated malignancy, and lymphoma was suspected. A mediastinal biopsy showed a mycobacterial spindle cell pseudotumour containing acid and alcohol fast bacilli (AAFB). Sputum microscopy demonstrated AAFBs, confirmed as Mycobacterium tuberculosis complex by PCR. Prolonged culture grew Mycobacterium microti, an organism often associated with disease in small rodents and llamas. M microti isolates from postmortem samples of an alpaca at a nearby farm were genetically indistinguishable. Although the patient had not visited the farm, concurrent illness in her adopted stray cat suggested a possible zoonotic connection. The patient responded to antituberculous therapy, and rehydration and pamidronate for hypercalcaemia. We believe the hypercalcaemia was caused by a similar mechanism to raised calcium levels sometimes seen in tuberculosis.
Assuntos
Antituberculosos/uso terapêutico , Histiócitos/microbiologia , Hipercalcemia/microbiologia , Mycobacterium/isolamento & purificação , Granuloma de Células Plasmáticas Pulmonar/microbiologia , Tuberculose/microbiologia , Adulto , Animais , Biópsia , Camelídeos Americanos/microbiologia , Gatos/microbiologia , Diagnóstico Diferencial , Feminino , Humanos , Hospedeiro Imunocomprometido , Reação em Cadeia da Polimerase , Escarro/microbiologia , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológicoAssuntos
Hipercalcemia/microbiologia , Infecções por Mycobacterium não Tuberculosas/complicações , Mycobacterium marinum , Insuficiência Renal/microbiologia , Humanos , Hipercalcemia/imunologia , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Infecções por Mycobacterium não Tuberculosas/imunologia , Tomografia por Emissão de Pósitrons , Insuficiência Renal/imunologiaRESUMO
Soft tissue calcification is a frequent complication in end-stage renal disease (ESRD) patients with a high serum calcium-phosphate product, but systemic involvement of both the visceral organs and skin is rarely seen. We report on a newly diagnosed ESRD patient with gouty nephropathy who had initial presentations of extensive intradermal tophi, diffuse calcinosis, and hypercalcemia. He received maintenance hemodialysis (HD) with low-calcium dialysate (1.25 mEq/l) for 11 months. Although the above complications diminished, serum calcium remained elevated. Thereafter, unexpected cervical lymphadenitis from a Mycobacterium tuberculosis (TB) infection with high extra-renal production of calcitriol was found. Serum calcium levels normalized only after anti-TB treatment for 2 months. We thought that this patient might have had occult TB infection before the start of HD, which resulted in calcitriol production and hypercalcemia. In addition, concomitant hyperphosphatemia in chronic renal failure contributed to severe diffuse calcinosis. After the initiation of HD therapy, both the elevated serum calcitriol levels and accelerated resolution and mobilization of diffuse calcinosis from low-calcium HD contributed to persistent hypercalcemia.
Assuntos
Calcinose/etiologia , Hipercalcemia/etiologia , Diálise Renal/métodos , Uremia/complicações , Adulto , Calcinose/microbiologia , Cálcio/administração & dosagem , Cálcio/sangue , Soluções para Diálise/química , Humanos , Hipercalcemia/microbiologia , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Mycobacterium tuberculosis , Tuberculose dos Linfonodos/complicações , Tuberculose dos Linfonodos/tratamento farmacológicoRESUMO
BACKGROUND: Of the 13 reported cases of hypercalcemia associated with fungal infection, 1 was caused by Cryptococcus neoformans and probably mediated by increased levels of 1,25-dihydroxyvitamin D [1,25(OH)2D]. Eight others were associated with Coccidioides immitis, of which only 2 had measured 1,25(OH)2D levels; in both, they were diminished. We report a patient with human immunodeficiency virus infection and simultaneous C. immitis and C. neoformans pneumonia and C. immitis fungemia associated with hypercalcemia. METHODS: Consecutive measurements of serum total and ionized calcium, phosphorous, blood urea nitrogen, creatinine, 25(OH)D, 1,25(OH)2D, parathyroid hormone (PTH), parathyroid hormone-related protein (PTHrp) and albumin were performed over a period of 46 months. RESULTS: While the patient was hypercalcemic, intact serum PTH and PTHrp were undetectable, serum 25(OH)D levels were normal, and serum 1,25(OH)2D levels were in the high normal range. Successful treatment of the C. immitis and C. neoformans infections resulted in resolution of the hypercalcemia and increase of PTH and PTHrp to the normal range. CONCLUSION: In some patients with HIV infection, coincident hypercalcemia, and severe fungal infection, the responsible factor may be 1,25(OH)2D. Although total serum levels of this compound may not be frankly elevated, they are inappropriately high for the circumstances. Free 1,25(OH)2D levels should be determined in this situation.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Coccidioidomicose/complicações , Criptococose/complicações , Hipercalcemia/microbiologia , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/microbiologia , Vitamina D/análogos & derivados , Infecções Oportunistas Relacionadas com a AIDS/sangue , Adulto , Cryptococcus neoformans , Humanos , Hipercalcemia/sangue , Pneumopatias Fúngicas/sangue , Pneumopatias Fúngicas/patologia , Masculino , Hormônio Paratireóideo/sangue , Proteína Relacionada ao Hormônio Paratireóideo , Proteínas/metabolismo , Vitamina D/sangueRESUMO
This article describes a patient in whom disseminated infection with coccidioidomycosis was associated with hypercalcemia. The patient had a low level of 1,25-dihydroxyvitamin D and a suppressed parathyroid hormone value, an indication that the hypercalcemia was not mediated by vitamin D or parathyroid hormone. The episode resolved readily with administration of pamidronate, an outcome suggesting that this is effective treatment of hypercalcemia of this origin. On follow-up of the patient while he was receiving antifungal therapy for Coccidioides immitis, calcium values remained normal.
Assuntos
Coccidioidomicose/complicações , Hipercalcemia/microbiologia , Adulto , Antifúngicos/uso terapêutico , Osso e Ossos/efeitos dos fármacos , Coccidioidomicose/tratamento farmacológico , Difosfonatos/uso terapêutico , Humanos , Hipercalcemia/tratamento farmacológico , Masculino , PamidronatoRESUMO
This report deals with a young man having prolonged fever presenting with hypercalcaemic crisis. Subsequent investigations confirmed tuberculosis (TB) peritonitis in the absence of pulmonary involvement as the cause of his symptoms. His hypercalcaemia and fever resolved with anti-TB therapy. Abdominal TB needs to be included in the differential diagnosis of otherwise unexplained hypercalcaemia especially in our region where TB is an endemic problem and is treatable.
Assuntos
Hipercalcemia/microbiologia , Peritonite Tuberculosa/complicações , Peritonite/microbiologia , Adulto , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Febre/etiologia , Humanos , Masculino , Peritonite Tuberculosa/tratamento farmacológicoRESUMO
Hypercalcemia is associated with numerous chronic granulomatous processes and chronic infections. Increased production of 1,25-dihydroxyvitamin D by activated macrophages has been shown to be the cause in most cases. In this article, we describe a case of hypercalcemia related to infection with Nocardia asteroides. In a 34-year-old woman who previously had hypocalcemia, acute hypercalcemia developed coincident with Nocardia pericarditis. The hypercalcemia resolved after treatment of N. asteroides with sulfisoxazole. Parathyroid hormone and phosphorus levels were within normal limits, and total 25-hydroxyvitamin D levels were only mildly increased. After successful treatment of the Nocardia infection, the patient required supplemental calcium and vitamin D. Her hypercalcemia was temporally related to the duration of the N. asteroides infection. We believe this is the first reported case of hypercalcemia associated with N. asteroides infection.
Assuntos
Hipercalcemia/etiologia , Hipoparatireoidismo/complicações , Nocardiose/complicações , Nocardia asteroides , Adulto , Antibacterianos/uso terapêutico , Feminino , Humanos , Hipercalcemia/microbiologia , Nocardiose/tratamento farmacológico , Sulfisoxazol/uso terapêuticoRESUMO
We describe a 4 year old girl with acute Aeromonas hydrophila gastro-enteritis who presented with a combination of hypercalcemia, metabolic alkalosis, and renal impairment. Serum parathyroid hormone was not elevated. Both milk-alkali syndrome and intoxication of vitamins A and D were ruled out. The hypercalcemia, metabolic alkalosis, and renal impairment were improved by fluid infusion and intravenous administration of furosemide. Gastro-enteritis also improved with oral administration of the antibiotic norfloxacin. The association of A. hydrophila gastro-enteritis with hypercalcemia has not been described previously.