Hypercalcaemia in Mycobacterium kansasii pulmonary infection

• Published in: BMJ case reports Vol. 14; no. 11; p. e245800
• Main Authors: Flowers, Robert Costigan, Ocampo, Javier, Krautbauer, Justin, Kupin, Warren L
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 30.11.2021; BMJ Publishing Group
• Subjects: Aged; Anemia; Antibiotics; Biopsy; Bone marrow; Bronchoscopy; Calcium; Cardiac arrhythmia; Cardiovascular disease; Case Report; Case reports; Coronary vessels; Creatinine; Disease prevention; Etiology; Fecal incontinence; Hematology; Hemoglobin; Hospitals; Humans; Hypercalcemia; Hypercalcemia - diagnosis; Hypercalcemia - drug therapy; Hypercalcemia - etiology; Infections; Kidney diseases; Laboratories; Lung; Lung Diseases - complications; Lung Diseases - diagnosis; Lung Diseases - microbiology; Male; Multiple myeloma; Mycobacterium Infections, Nontuberculous - complications; Mycobacterium Infections, Nontuberculous - diagnosis; Mycobacterium kansasii; Parathyroid Hormone; Physical therapy; Sarcoidosis; Transplants & implants; Tuberculosis; Viral infections; TB and other respiratory infections; calcium and bone; pneumonia (respiratory medicine); immunology; renal transplantation
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-245800

A gentleman in his 60s with end-stage kidney disease status post kidney transplantation on prednisone and tacrolimus presented with generalised weakness for 7 days, associated with altered mental status. Investigations revealed pancytopenia, acute kidney injury, hypercalcaemia, decreased parathyroid hormone (PTH) and normal calcitriol levels. CT of the chest showed multifocal lung opacities suspicious for malignancy. Bronchoscopy with biopsy yielded no malignant cells, and bronchoalveolar lavage specimens grew The patient was treated with bisphosphonates, calcitonin and antibiotics for non-tuberculous mycobacteria pulmonary infection, with improvement in serum calcium levels, and was discharged after 5 weeks of hospitalisation.The work-up for hypercalcaemia begins with PTH measurement, and low PTH levels are consistent with malignancy, immobilisation and granulomatous diseases. Hypercalcaemia in the lattermost is classically caused by overproduction of calcitriol by activated macrophages. However, there are case reports of mycobacterial infections with hypercalcaemia despite normal calcitriol levels, supporting the existence of an additional mechanism of hypercalcaemia in granulomatous infections.