PT  - JOURNAL ARTICLE
AU  - Robert Costigan Flowers
AU  - Javier Ocampo
AU  - Justin Krautbauer
AU  - Warren L Kupin
TI  - Hypercalcaemia in <em>Mycobacterium kansasii</em> pulmonary infection
AID  - 10.1136/bcr-2021-245800
DP  - 2021 Nov 01
TA  - BMJ Case Reports
PG  - e245800
VI  - 14
IP  - 11
4099  - http://casereports.bmj.com/content/14/11/e245800.short
4100  - http://casereports.bmj.com/content/14/11/e245800.full
SO  - BMJ Case Reports2021 Nov 01; 14
AB  - 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 Mycobacterium kansasii. 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.