Hypercalcaemia has been known to be associated with tuberculosis since 1931 and has recently been reported to occur commonly.' The hypercalcaemia is generally asymnptomatic and mild. We describe a case with symptoms and also report a study of the prevalence of hypercalcaemia in 89 tuberculous patients. Case reportA 25-year-old man presented with a history of rigors, night sweats, and productive cough for two weeks. He smoked 10 cigarettes a day, drank alcohol socially, and took no medication. On examination he was feverish (38-6'C), chest radiography confirmed the signs of right upper lobe consolidation and collapse,, and his sputum grew Mycobacterium tuberculosis.Biochemical analyses (Technicon SMAC) showed hypercalcaemia (plasma calcium concentration 2-72 mmol/I (10-9 mg/l00 ml)) and hypoalbuminaemia (serum albumin 27 g/l). He was given rifampicin 600 mg, isoniazid 300 mg, pyridoxine 6 mg, ethambutol 1500 mg, and streptomycin 1 g daily. After 19 days he became drowsy, polyuric, dehydrated, and his plasma calcium concentration was 3 33 mmol/l (13.3 mg/100 ml). The results of serum and urine electrophoresis and thyroid function tests were unremarkable and serum parathyroid hormone was undetectable. He was given phosphate by mouth and forced fluids, and he rapidly became more conscious. The plasma calcium concentration became normal by 12 weeks and remained normal two years later.

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