A case of extrapulmonary tuberculosis in a patient with end-stage renal disease with elevated parathyroid hormone–related protein

Abstract

The diagnosis of extrapulmonary tuberculosis in patients with end-stage renal disease can be challenging as the signs and symptoms are often non-specific. In this study, we present a case of extrapulmonary tuberculosis in an Ethiopian woman with end-stage renal disease who had subcarinal and right hilar lymphadenopathy, moderate sized right pleural effusion, hypercalcemia, and elevated parathyroid hormone–related protein in the setting of an elevated 1,25-dihydroxyvitamin D. After being started on appropriate tuberculosis treatment, patient’s parathyroid hormone–related protein level decreased and calcium level normalized. Our literature review showed that the elevation of parathyroid hormone–related protein in extrapulmonary tuberculosis has not been well studied, and it is our aim to explore the role of parathyroid hormone–related protein in extrapulmonary tuberculosis.

Hypercalcaemia inMycobacterium kansasiipulmonary infection

“…This protein is characteristic of humoral hypercalcaemia of malignancy but has been described as a less frequent mechanism of action in granulomatous diseases like sarcoidosis 12 18–20. Reports of this phenomenon are rare in mycobacterial disease, including case descriptions of disseminated M. tuberculosis,21 and M. haemophilum 10. One case series of patients with hypercalcaemia and elevated PTHrP showed that 12 of 138 patients had no diagnosed solid or haematologic malignancy despite appropriate workup, 22.…”