Severe Hypercalcemia as the Presenting Sign of Tuberculosis

Severe hypercalcemia due to tuberculosis (TB) is rare. We describe a case of a 25-year-old male who was found to have a serum calcium level 15.4 mg/dL at a routine appointment prompting admission. Chest imaging demonstrated hilar lymphadenopathy and airspace opacities principally involving the lingula. Multiple sputum smears were negative for acid-fast bacilli (AFB), but cultures of sputum subsequently grew Mycobacterium tuberculosis . Despite appropriate therapy for TB, his serum calcium failed to normalize, prompting initiation of prednisone with rapid improvement. In granulomatous diseases, including TB, inflammation is mediated in part by elevated calcitriol released from macrophages, with resulting rises in serum calcium concentrations. Glucocorticoids are commonly used as adjunctive therapy for TB meningitis and pericarditis and this case emphasizes the potential role for steroids in refractory hypercalcemia. J Med Cases. 2015;6(8):382-384 doi: http://dx.doi.org/10.14740/jmc2220w