A rare case of intestinal tuberculosis associated hypercalcaemia

A rare case of intestinal tuberculosis associated hypercalcaemia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A rare case of intestinal tuberculosis associated hypercalcaemia Tilan Aponso, W. S. Wanninayaka, N. M.M. Nawarathna This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4071125/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Tuberculosis is a disease that can affect many organs in the human body and is caused by Mycobacterium tuberculosis. Abdominal tuberculosis is uncommon, with a reported incidence of 2.5% among extrapulmonary tuberculosis patients in the United States. Hypercalcemia in tuberculosis is a rare complication with a prevalence that varies between 2.3 and 28%. Most hypercalcemic patients with tuberculosis remain asymptomatic. (88%) We report a patient with non-PTH-related hypercalcemia as the presenting complaint who was later diagnosed with intestinal tuberculosis. Figures Figure 1 Introduction Tuberculosis is a disease that can affect every organ in the human body and is caused by Mycobacterium tuberculosis. Roughly 10 million people were infected with Mycobacterium tuberculosis in 2017, and 1.3 million patients died due to tuberculosis. ( 1 ) Among tuberculosis patients, around 14% had extrapulmonary tuberculosis in 2017, and around 2.5% were reported to have intestinal tuberculosis. ( 2 ) Among patients with extrapulmonary tuberculosis, 15–20% had concomitant pulmonary tuberculosis. ( 3 ) Abdominal tuberculosis can affect the entire gastrointestinal tract, including the mouth to the anus (49%), peritoneum (42%), mesenteric lymph nodes (4%) and the solid organs, including the liver and pancreas (5%). ( 4 ) The presentation of abdominal tuberculosis is nonspecific, and 85% of the patients had abdominal pain. Loss of weight (66%), fever (35–50%), diarrhea (20%), malabsorption (21–75%), and mass in the right lower quadrant (25–50%) are some other frequent presentations. ( 5 ) Hypercalcemia in tuberculosis is a rare complication with a prevalence that varies between 2.3 and 28%. ( 6 ) Most of the hypercalcemic patients with tuberculosis remain asymptomatic. (88%) ( 7 ) Case report A 29-year-old male patient presented with nonspecific right lower abdominal pain and loss of weight for 3 months. On examination, he was cachectic. Respiratory and other system examinations were unremarkable. He had an iron deficiency anemia (Hb 8.5 g/L) with normal liver biochemistry and renal function tests and elevated inflammatory markers (ESR 65 mm/1 hr). His corrected serum calcium level was 3.1 mmol/L (normal value: 2.2 to 2.7 mmol/L) with a phosphate of 1.37 mmol/L (normal value: 1.12 to 1.45 mmol/L). 25 (OH) vitamin D level was 8 ng/mL (normal values of 20 and 40 ng/mL). His intact parathyroid hormone level was 6 pg/mL( normal value: 10–65 pg/mL). Chest radiography was normal, with a negative sputum AFB. He underwent CECT abdomen and was found to have circumferentially enhanced wall thickening involving the terminal ileum and the caecum, causing luminal narrowing (Fig. 1 ). He had a positive stool calprotectin on qualitative analysis. On colonoscopic examination, a distorted ileocaecal valve with patchy inflammation and transverse ulcers were present in the terminal ileum. (Fig. 1 ). On histology, there were granulomas composed of epithelioid histiocytes with necrosis, submucosal inflammation, cryptitis, and crypt abscesses. His Mantoux test and TB PCR on the biopsy sample were positive. He was started on antituberculosis treatment and had a good clinical response, a normal repeat CECT abdomen, corrected calcium, and complete mucosal healing on repeat endoscopy 6 months after antituberculosis treatment. Discussion Hypercalcemia has a prevalence rate of 1% of the worldwide population. ( 8 ) Hypercalcemia can be parathyroid hormone-dependent or independent. Non-PTH-related hypercalcemia occurs in malignancies, granulomatous diseases, endocrinopathies, and vitamin D intoxication. Squamous cell carcinoma of the head, neck, and lungs, breast carcinoma, ovarian carcinoma, renal carcinoma, and hematological malignancies like leukemia and lymphomas are some of the malignant causes of hypercalcemia. If the calcium level is less than 12 mg/dL (3 mmol/L), it is called mild hypercalcemia. Between 12 and 14 mg/dL (3–3.5 mmol/L), it is called moderate, and more than 14 mg/dL (3.5 mmol/L), it is called severe hypercalcemia. In a patient with severe hypercalcemia, malignancies are an important differential diagnosis to exclude, and hypercalcemia in a malignant patient is a poor prognostic marker. Our patient had moderate, non-PTH-related hypercalcemia. ( 8 ) Hodgkin lymphoma, non-Hodgkin lymphoma, and granulomatous diseases like sarcoidosis and tuberculosis can cause hypercalcemia by increasing 1,25-dihydroxyvitamin D production. Patients with tuberculosis generally develop asymptomatic, mild hypercalcemia. Hypercalcemia is associated with all forms of tuberculosis, and severe hypercalcemia can present in disseminated tuberculosis. ( 11 ) Our patient had non-PTH-related hypercalcemia and intestinal tuberculosis. The presenting symptom was nonspecific, dull abdominal pain. 85% of intestinal tuberculosis patients had abdominal pain ( 5 ), but in this patient, hypercalcemia-related abdominal pain, acute pancreatitis, and obstructive uropathy were some other causes of abdominal pain that we have excluded. The mechanisms underlying the development of hypercalcemia are multifactorial. In the past, hypercalcemia in tuberculosis was associated with cod liver oil supplementation for lupus vulgaris ( 9 ). But now several mechanisms have been identified for the development of hypercalcemia in tuberculosis. Alterations in the metabolism of vitamin D, isoniazide, or tuberculosis-induced increased osteoclast activity can cause hypercalcemia in tuberculosis. In tuberculosis, macrophages involved in the development of granulomas cause extra renal hydroxylation of 25-hydroxycholcalciferol to 1,25-dihydroxycholecalciferol. 1,25-dihydroxycholecalciferol improves the capacity of the macrophages to kill mycobacteria. If this process occurs on a large scale, 1,25-dihydroxycholecalciferol can enter the circulation, resulting in hypercalcemia. ( 10 , 12 ) In a resource-poor setting, we were unable to measure 1,25-dihydroxycholecalciferol levels in our patient. In hypercalcemic patients with increased 1,25-dihydroxyvitamin D levels, lymphomas, tuberculosis, and sarcoidosis, glucocorticoids should be considered. Steroids decrease vitamin D production and calcium absorption from the intestines. Hypercalcemia is one indication to start steroids in a tuberculosis patient. Our patient was treated with a short course of oral steroids and antituberculosis drugs and had a good response to treatment. Conclusion Tuberculosis is a mysterious bacteria that can affect any organ in the body. Hypercalcemia is a rare complication of tuberculosis, and as clinicians working in areas with a high prevalence of tuberculosis, it is important to exclude tuberculosis when suspecting a cause for non-PTH-related hypercalcemia. Declarations Acknowledgements Not applicable Funding None Author information Affiliations Dr.Tilan Aponso & Dr N.M.M.Nawarathna - Department of gastroenterology, National Hospital of Sri Lanka City – Colombo Country – Sri Lanka Dr W.M.D.A.S.Wanninayaka – Department of Medicine, National Hospital of Sri Lanka City – Colombo Country – Sri Lanka Contribution Dr Tilan Aponso and Dr.W.M.D.A.S. Wanninayaka did the literature review and writing of the initial manuscript was done by Dr Tilan Aponso. Dr N.M.M.Nawarathna finalized the manuscript and gave expert opinion. All the authors read and approved the final manuscript. Corresponding author Correspondence to Dr. Tilan Aponso Ethical declaration Not applicable Consent for publication Informed written consent for publication of details was taken from the patient. Consent form can be made available to the editor on request. Competing interests Authors declare that they have no competing interests. Availability of data and materials The data is available from the corresponding author on reasonable request. References World Health Organization. Tuberculosis: key facts [Internet]. Geneva: World Health Organization; 2020 [cited 2021 Mar 31]. Raviglione MC. Tuberculosis. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Education; 2018. p. 1236–58. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol. 1993;88(7):989–99. Abbas Z. Abdominal tuberculosis. In: Hasan M, Akbar MF, Al-Mahtab M, editors. Textbook of Hepato-Gastroenterology. New Delhi: Jaypee Brothers Medical Pub; 2015. p. 68–76. Pattanayak S, Behuria S. Is abdominal tuberculosis a surgical problem? Ann R Coll Surg Engl. 2015;97(6):414–9. Abbasi AA, Chemplavil JK, Farah S, Muller BF, Arnstein AR. Hypercalcemia in active pulmonary tuberculosis. Ann Intern Med. 1979;90:324–8. Arrais Morais M, Cardoso Teixeira LL, de Sousa Brandão Torres D, da Rocha Klautau Neto PB, Machado Kahwage A. Localized hepatic tuberculosis presenting as severe hypercalcemia. Indian J Tuberc 2018;65:172‑4. Walker MD, Shane E. Hypercalcemia: A Review. JAMA. 2022 Oct 25;328(16):1624-1636. doi: 10.1001/jama.2022.18331. PMID: 36282253. Sharma OP. Hypercalcemia in granulomatous disorders: A clinical review Curr Opin Pulm Med. 2000;6:442–7 Abbasi AA, Chemplavil JK, Farah S, Muller BF, Arnstein AR. Hypercalcemia in active pulmonary tuberculosis Ann Intern Med. 1979;90:324–8 Abdullah AS, Adel AM, Hussein RM, Abdullah MA, Yousaf A, Mudawi D, et al. Hypercalcemia and acute pancreatitis in a male patient with acute promyelocytic leukemia and pulmonary tuberculosis. Acta Biomed 2018;89:23‑7. Cadranel J, Garabedian M, Milleron B, Guillozo H, Akoun G, Hance AJ. 1,25(OH) 2D2 production by T lymphocytes and alveolar macrophages recovered by lavage from normocalcemic patients with tuberculosis. J Clin Invest. 1990;85:1588–93. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4071125","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":283000913,"identity":"4c47ac9a-a9cd-4e6b-8c80-270aa7d09013","order_by":0,"name":"Tilan Aponso","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYDACZuYGBoYKGzkQ+8ADYnTwMDMCtZxJMwZrSSBKCwNQC2Pb4cQGEI8oLfbsjI2fC84cTp8fdvgh0BY7Od0Gwg5rlp5RkZ678XaaAVBLsrHZAcJaGqR5zljnbpydANJyIHEbEVqaf/O2Macbzk7/QLSWNmneNucEeekcYm05zNhmzXMmzXCDdE7BgQQDIvzC3n/48G2eCht5+dnpmz98qLCTI6gFDgzAKg2IVQ4C8g2kqB4Fo2AUjIIRBQChlkKWrirI9wAAAABJRU5ErkJggg==","orcid":"","institution":"National Hospital of Sri Lanka","correspondingAuthor":true,"prefix":"","firstName":"Tilan","middleName":"","lastName":"Aponso","suffix":""},{"id":283000914,"identity":"f0a55647-314a-4879-92b4-6b66182c604d","order_by":1,"name":"W. S. Wanninayaka","email":"","orcid":"","institution":"National Hospital of Sri Lanka","correspondingAuthor":false,"prefix":"","firstName":"W.","middleName":"S.","lastName":"Wanninayaka","suffix":""},{"id":283000915,"identity":"d1f6ea6b-d5d4-449b-8496-25a4932f5104","order_by":2,"name":"N. M.M. Nawarathna","email":"","orcid":"","institution":"National Hospital of Sri Lanka","correspondingAuthor":false,"prefix":"","firstName":"N.","middleName":"M.M.","lastName":"Nawarathna","suffix":""}],"badges":[],"createdAt":"2024-03-11 07:49:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4071125/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4071125/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53582255,"identity":"bfa38282-4de0-4375-a8d1-cce05cdf3b94","added_by":"auto","created_at":"2024-03-27 17:39:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":340141,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCECT abdomen and colonoscopy images\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4071125/v1/05e301a0db98839ef56b6775.png"},{"id":53586560,"identity":"0f1d5a8a-28f3-42ca-8687-26978ee80fa0","added_by":"auto","created_at":"2024-03-27 18:38:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":491356,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4071125/v1/9c29f6c6-1b73-46da-b0d0-70a9f27c3e4b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A rare case of intestinal tuberculosis associated hypercalcaemia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTuberculosis is a disease that can affect every organ in the human body and is caused by Mycobacterium tuberculosis. Roughly 10\u0026nbsp;million people were infected with Mycobacterium tuberculosis in 2017, and 1.3\u0026nbsp;million patients died due to tuberculosis. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Among tuberculosis patients, around 14% had extrapulmonary tuberculosis in 2017, and around 2.5% were reported to have intestinal tuberculosis. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Among patients with extrapulmonary tuberculosis, 15\u0026ndash;20% had concomitant pulmonary tuberculosis. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAbdominal tuberculosis can affect the entire gastrointestinal tract, including the mouth to the anus (49%), peritoneum (42%), mesenteric lymph nodes (4%) and the solid organs, including the liver and pancreas (5%). (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) The presentation of abdominal tuberculosis is nonspecific, and 85% of the patients had abdominal pain. Loss of weight (66%), fever (35\u0026ndash;50%), diarrhea (20%), malabsorption (21\u0026ndash;75%), and mass in the right lower quadrant (25\u0026ndash;50%) are some other frequent presentations. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Hypercalcemia in tuberculosis is a rare complication with a prevalence that varies between 2.3 and 28%. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Most of the hypercalcemic patients with tuberculosis remain asymptomatic. (88%) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e"},{"header":"Case report","content":"\u003cp\u003eA 29-year-old male patient presented with nonspecific right lower abdominal pain and loss of weight for 3 months. On examination, he was cachectic. Respiratory and other system examinations were unremarkable.\u003c/p\u003e \u003cp\u003eHe had an iron deficiency anemia (Hb 8.5 g/L) with normal liver biochemistry and renal function tests and elevated inflammatory markers (ESR 65 mm/1 hr). His corrected serum calcium level was 3.1 mmol/L (normal value: 2.2 to 2.7 mmol/L) with a phosphate of 1.37 mmol/L (normal value: 1.12 to 1.45 mmol/L). 25 (OH) vitamin D level was 8 ng/mL (normal values of 20 and 40 ng/mL). His intact parathyroid hormone level was 6 pg/mL( normal value: 10\u0026ndash;65 pg/mL). Chest radiography was normal, with a negative sputum AFB. He underwent CECT abdomen and was found to have circumferentially enhanced wall thickening involving the terminal ileum and the caecum, causing luminal narrowing (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). He had a positive stool calprotectin on qualitative analysis. On colonoscopic examination, a distorted ileocaecal valve with patchy inflammation and transverse ulcers were present in the terminal ileum. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). On histology, there were granulomas composed of epithelioid histiocytes with necrosis, submucosal inflammation, cryptitis, and crypt abscesses. His Mantoux test and TB PCR on the biopsy sample were positive.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHe was started on antituberculosis treatment and had a good clinical response, a normal repeat CECT abdomen, corrected calcium, and complete mucosal healing on repeat endoscopy 6 months after antituberculosis treatment.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHypercalcemia has a prevalence rate of 1% of the worldwide population. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Hypercalcemia can be parathyroid hormone-dependent or independent. Non-PTH-related hypercalcemia occurs in malignancies, granulomatous diseases, endocrinopathies, and vitamin D intoxication. Squamous cell carcinoma of the head, neck, and lungs, breast carcinoma, ovarian carcinoma, renal carcinoma, and hematological malignancies like leukemia and lymphomas are some of the malignant causes of hypercalcemia.\u003c/p\u003e \u003cp\u003eIf the calcium level is less than 12 mg/dL (3 mmol/L), it is called mild hypercalcemia. Between 12 and 14 mg/dL (3\u0026ndash;3.5 mmol/L), it is called moderate, and more than 14 mg/dL (3.5 mmol/L), it is called severe hypercalcemia. In a patient with severe hypercalcemia, malignancies are an important differential diagnosis to exclude, and hypercalcemia in a malignant patient is a poor prognostic marker. Our patient had moderate, non-PTH-related hypercalcemia. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eHodgkin lymphoma, non-Hodgkin lymphoma, and granulomatous diseases like sarcoidosis and tuberculosis can cause hypercalcemia by increasing 1,25-dihydroxyvitamin D production. Patients with tuberculosis generally develop asymptomatic, mild hypercalcemia. Hypercalcemia is associated with all forms of tuberculosis, and severe hypercalcemia can present in disseminated tuberculosis. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Our patient had non-PTH-related hypercalcemia and intestinal tuberculosis. The presenting symptom was nonspecific, dull abdominal pain. 85% of intestinal tuberculosis patients had abdominal pain (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), but in this patient, hypercalcemia-related abdominal pain, acute pancreatitis, and obstructive uropathy were some other causes of abdominal pain that we have excluded.\u003c/p\u003e \u003cp\u003eThe mechanisms underlying the development of hypercalcemia are multifactorial. In the past, hypercalcemia in tuberculosis was associated with cod liver oil supplementation for lupus vulgaris (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). But now several mechanisms have been identified for the development of hypercalcemia in tuberculosis. Alterations in the metabolism of vitamin D, isoniazide, or tuberculosis-induced increased osteoclast activity can cause hypercalcemia in tuberculosis. In tuberculosis, macrophages involved in the development of granulomas cause extra renal hydroxylation of 25-hydroxycholcalciferol to 1,25-dihydroxycholecalciferol. 1,25-dihydroxycholecalciferol improves the capacity of the macrophages to kill mycobacteria. If this process occurs on a large scale, 1,25-dihydroxycholecalciferol can enter the circulation, resulting in hypercalcemia. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) In a resource-poor setting, we were unable to measure 1,25-dihydroxycholecalciferol levels in our patient.\u003c/p\u003e \u003cp\u003eIn hypercalcemic patients with increased 1,25-dihydroxyvitamin D levels, lymphomas, tuberculosis, and sarcoidosis, glucocorticoids should be considered. Steroids decrease vitamin D production and calcium absorption from the intestines. Hypercalcemia is one indication to start steroids in a tuberculosis patient. Our patient was treated with a short course of oral steroids and antituberculosis drugs and had a good response to treatment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTuberculosis is a mysterious bacteria that can affect any organ in the body. Hypercalcemia is a rare complication of tuberculosis, and as clinicians working in areas with a high prevalence of tuberculosis, it is important to exclude tuberculosis when suspecting a cause for non-PTH-related hypercalcemia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAffiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr.Tilan Aponso \u0026amp; Dr N.M.M.Nawarathna - Department of gastroenterology, National Hospital of Sri Lanka\u003c/p\u003e\n\u003cp\u003eCity \u0026ndash; Colombo\u003c/p\u003e\n\u003cp\u003eCountry \u0026ndash; Sri Lanka\u003c/p\u003e\n\u003cp\u003eDr W.M.D.A.S.Wanninayaka \u0026ndash; Department of Medicine, National Hospital of Sri Lanka\u003c/p\u003e\n\u003cp\u003eCity \u0026ndash; Colombo\u003c/p\u003e\n\u003cp\u003eCountry \u0026ndash; Sri Lanka\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr Tilan Aponso and Dr.W.M.D.A.S. Wanninayaka did the literature review and writing of the initial manuscript was done by Dr Tilan Aponso. Dr N.M.M.Nawarathna finalized the manuscript and gave expert opinion. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Dr. Tilan Aponso\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed written consent for publication of details was taken from the patient. Consent form can be made available to the editor on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data is available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization. Tuberculosis: key facts [Internet]. Geneva: World Health Organization; 2020 [cited 2021 Mar 31].\u003c/li\u003e\n \u003cli\u003eRaviglione MC. Tuberculosis. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison\u0026rsquo;s Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Education; 2018. p. 1236\u0026ndash;58.\u003c/li\u003e\n \u003cli\u003eMarshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol. 1993;88(7):989\u0026ndash;99.\u003c/li\u003e\n \u003cli\u003eAbbas Z. Abdominal tuberculosis. In: Hasan M, Akbar MF, Al-Mahtab M, editors. Textbook of Hepato-Gastroenterology. New Delhi: Jaypee Brothers Medical Pub; 2015. p. 68\u0026ndash;76.\u003c/li\u003e\n \u003cli\u003ePattanayak S, Behuria S. Is abdominal tuberculosis a surgical problem? Ann R Coll Surg Engl. 2015;97(6):414\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eAbbasi AA, Chemplavil JK, Farah S, Muller BF, Arnstein AR. Hypercalcemia in active pulmonary tuberculosis. \u003cem\u003eAnn Intern Med. \u003c/em\u003e1979;90:324\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eArrais Morais M, Cardoso Teixeira LL, de Sousa Brand\u0026atilde;o Torres D, da Rocha Klautau Neto PB, Machado Kahwage A. Localized hepatic tuberculosis presenting as severe hypercalcemia. Indian J Tuberc 2018;65:172‑4. \u003c/li\u003e\n \u003cli\u003eWalker MD, Shane E. Hypercalcemia: A Review. JAMA. 2022 Oct 25;328(16):1624-1636. doi: 10.1001/jama.2022.18331. PMID: 36282253.\u003c/li\u003e\n \u003cli\u003eSharma OP. Hypercalcemia in granulomatous disorders: A clinical review Curr Opin Pulm Med. 2000;6:442\u0026ndash;7\u003c/li\u003e\n \u003cli\u003eAbbasi AA, Chemplavil JK, Farah S, Muller BF, Arnstein AR. Hypercalcemia in active pulmonary tuberculosis Ann Intern Med. 1979;90:324\u0026ndash;8\u003c/li\u003e\n \u003cli\u003eAbdullah AS, Adel AM, Hussein RM, Abdullah MA, Yousaf A, Mudawi D, et al. Hypercalcemia and acute pancreatitis in a male patient with acute promyelocytic leukemia and pulmonary tuberculosis. Acta Biomed 2018;89:23‑7.\u003c/li\u003e\n \u003cli\u003eCadranel J, Garabedian M, Milleron B, Guillozo H, Akoun G, Hance AJ. 1,25(OH) 2D2 production by T lymphocytes and alveolar macrophages recovered by lavage from normocalcemic patients with tuberculosis. \u003cem\u003eJ Clin Invest. \u003c/em\u003e1990;85:1588\u0026ndash;93. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4071125/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4071125/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTuberculosis is a disease that can affect many organs in the human body and is caused by Mycobacterium tuberculosis. Abdominal tuberculosis is uncommon, with a reported incidence of 2.5% among extrapulmonary tuberculosis patients in the United States. Hypercalcemia in tuberculosis is a rare complication with a prevalence that varies between 2.3 and 28%. Most hypercalcemic patients with tuberculosis remain asymptomatic. (88%)\u003c/p\u003e \u003cp\u003eWe report a patient with non-PTH-related hypercalcemia as the presenting complaint who was later diagnosed with intestinal tuberculosis.\u003c/p\u003e","manuscriptTitle":"A rare case of intestinal tuberculosis associated hypercalcaemia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-27 17:39:47","doi":"10.21203/rs.3.rs-4071125/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1b1af0a9-002c-44fa-9c09-7b53f7448227","owner":[],"postedDate":"March 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-27T18:30:21+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-27 17:39:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4071125","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4071125","identity":"rs-4071125","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}