Steroid-Responsive Hypercalcemia in Disseminated Bone Tuberculosis

Abstract

There are many established causes of hypercalcemia. These include hyperparathyroidism, malignancies with or without bony metastases, sarcoidosis, bone atrophy, thyroid dysfunction, Addison disease, vitamin D intoxication, and the milk-alkali syndrome. 1 Hypercalcemia with disseminated bone tuberculosis is extremely rare. However, a case of miliary tuberculosis in which symptomatic hypercalcemia developed was reversed by corticosteroid therapy. Patient Summary A 28-year-old officer began serving a tour of duty in the Republic of Vietnam in September 1969. In March 1970, the patient noted the onset of fever, chills, nausea, and vomiting. A chest roentgenogram was normal, and peripheral blood smears revealed falciparum malaria. Despite several courses of antimalarial therapy and clearing of the parasitemia, fever persisted; and in late May, he was transferred to Walter Reed General Hospital. On admission, the patient complained of weakness, anorexia, and had a 9.04-kg weight loss. He was a thin, chronically ill appearing, white man in no