Massive cerebral tuberculomas, Pott's disease and hypercalcaemia secondary to Mycobacterium bovis in a patient with chronic kidney disease on peritoneal dialysis.
Mario E Alamilla-SanchezCarolina Gonzalez-FuentesJuan Daniel Diaz GarciaFrancisco Velasco Garcia LascurainPublished in: BMJ case reports (2024)
Tuberculosis (TB) is still a health problem in developing countries. Pulmonary involvement remains the most common clinical presentation. However, multiorgan involvement can be life-threatening. We present the case of a young woman on peritoneal dialysis who was admitted to hospitalisation for hypercalcaemia and low back pain. In his biochemical evaluation, suppressed intact parthyroid hormone (iPTH) and elevated 1,25-hydroxyvitamin D were detected. On a lumbar CT scan, a hypodense lesion in vertebral bodies compatible with Pott's disease was found. Positive cultures for Mycobacterium bovis were obtained in bronchoalveolar lavage and peritoneal fluid, for which specific treatment was initiated. Due to neurological deterioration, a CT scan was performed showing the presence of multiple tuberculomas. Retrospectively, the lack of an etiological diagnosis of chronic kidney disease, the initiation of dialysis 8 months before and the clear evidence of long-standing TB strongly suggest mycobacterium infection as the cause or trigger for the rapid decline in kidney function.
Keyphrases
- end stage renal disease
- peritoneal dialysis
- mycobacterium tuberculosis
- chronic kidney disease
- computed tomography
- dual energy
- pulmonary tuberculosis
- image quality
- contrast enhanced
- positron emission tomography
- healthcare
- public health
- pulmonary hypertension
- subarachnoid hemorrhage
- health information
- minimally invasive
- bone mineral density
- cerebral ischemia
- magnetic resonance
- human immunodeficiency virus
- postmenopausal women