Soofi A, Malik A, Khan J, S. Muzaffar S.
Severe hypercalcemia in Tuberculosis.
J Pak Med Assoc Jan ;54(4):213-15.

A 55 years old male presented with low grade fever, generalized weakness, weight loss, abdominal distension and constipation for 4 months and urinary frequency for 2 months. On examination, he looked cachectic with distended abdomen. There was no peripheral lymphadenopathy. Neurological and chest examination were normal. Abdominal examination revealed gross ascites. Laboratory workup showed normocytic normochromic anemia with a hemoglobin of 10.8 gm/dl, albumin of 2.4gm/dl, corrected hypercalcemia of 15mg/dl, raised alkaline phosphatase (764 IU/L) with normal parathyroid hormone level (19.7 pg/ml) and progressive renal failure. His serum creatinine rose from 0.9mg/dl two months prior to presentation to 4.1mg/dl three days post hospital admission. His ascetic fluid tap revealed exudative ascites. CT Scan of abdomen showed diffuse peritoneal thickening of posterior wall of stomach, lesser curvature, antrum and omentum. Trucut biopsy of peritoneum revealed chronic granulomatous inflammation. Patient was put on ATT with aggressive hydration. He showed improvement and his calcium decreased to 9.1mg/dl.

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