Hypercalcemia and Refractory Peritonitis Alert the Condition of Tuberculous Peritonitis: A Case Report and Review Literature
Worapot Treamtrakanpon MD*, Talerngsak Kanjanabuch MD*,**, Somchai Eiam-Ong MD*
Affiliation : * Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand ** Kidney & Metabolic Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Hypercalcemia is commonly encountered in peritoneal dialysis patients with parathyroid hormone abnormalities; however, most of them have faint clinical manifestation and the level usually is less than 13 mg/dL. If severe hypercalcemia exists, granulomatous infection and occult malignancy should be of concern. Tuberculosis, a granulomatous disease associated with hypercalcemia, is commonly prevalent in dialysis patients. Although anti-mycobacterium therapy is highly effective nowadays, the mortality rate is still high because most of the victims have delayed diagnosis. High index of suspiciousness and early diagnosis are mandatory to improve patient outcome. Herein, the authors report a case of TB peritonitis that was suspected because of the disclosure of hypercalcemia and refractoriness to an empirical antibiotic treatment.
Keywords : Hypercalcemia, Tuberculous peritonitis, CAPD
