Risk Factors for Hypercalcemia in Patients with Tuberculosis

Abstract

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.

Hypercalcemia in a 5-Year-Old Child with Disseminated Tuberculosis: Case Report and Literature Review

“… 1–6 There are several other potential triggers, such as coccidioidomycosis, histoplasmosis, Crohn’s disease, and Langerhans-cell histiocytosis. 3 , 6–8 …”

“…Hypercalcemia is one of the metabolic abnormalities in granulomatous disease like tuberculosis and sarcoidosis. [1][2][3][4][5][6] There are several other potential triggers, such as coccidioidomycosis, histoplasmosis, Crohn's disease, and Langerhans-cell histiocytosis. 3,[6][7][8] The incidence of hypercalcemia in adults with tuberculosis varies from 2% to 25% 2,3 depending on the geographical area where the study was conducted and depending on multiple other factors such as the intake of calcium, vitamin D, and exposure to the sun.…”

“…[1][2][3][4][5][6] There are several other potential triggers, such as coccidioidomycosis, histoplasmosis, Crohn's disease, and Langerhans-cell histiocytosis. 3,[6][7][8] The incidence of hypercalcemia in adults with tuberculosis varies from 2% to 25% 2,3 depending on the geographical area where the study was conducted and depending on multiple other factors such as the intake of calcium, vitamin D, and exposure to the sun. [1][2][3][4][5] Study done by John et al to determine the incidence, risk factor and clinical presentation of tuberculosis complicated by hypercalcemia, showed incidence of 20.15% and 34.6% of patients had symptoms of hypercalcemia.…”

“…25% of moderate and 50% of severe hypercalcemia patients had clinical symptoms. 6 The mechanism of hypercalcemia in tuberculosis is due to the extra-renal production of 1.25 (OH)2D3 by macrophages and T lymphocytes, possibly CD8 T lymphocytes. 7 Although no data are available for children, symptomatic hypercalcemia in tuberculosis in adults occurs only in 3%.…”

“…Relationship between type and stage of tuberculosis with serum calcium level is not clear, and discrepancies are noted in association with radiological extent of the disease. [4][5][6] Here we report a 5-year-old with disseminated tuberculosis complicated by hypercalcemia, who was successfully treated with anti-tuberculosis medication and hydration followed by dietary restriction of calcium and vitamin D.…”