Abstract: TH-PO0458
Persistent Hypercalcemia in a Patient with ESRD Leading to Diagnosis of Disseminated Tuberculosis via Cervical Biopsy
Session Information
- Hemodialysis: Novel Markers and Case Reports
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Pandya, Shan, Swedish Hospital, Chicago, Illinois, United States
- Batarseh, Tamara Ruth, Swedish Hospital, Chicago, Illinois, United States
- Amin, Janki P, Advocate Illinois Masonic Medical Center, Chicago, Illinois, United States
- Shetty, Ashwin R., Swedish Hospital, Chicago, Illinois, United States
- Savage, Joan, Erie Family Health Center, Chicago, Illinois, United States
Introduction
Chronic Kidney Disease and End Stage Renal Disease (ESRD) patients have an increased risk of cancer and tuberculosis (TB). Hypercalcemia can be seen with these diseases. Abnormal electrolytes are often attributed as a complication of renal disease. However, we present a case of an ESRD patient with persistent hypercalcemia ultimately diagnosed with disseminated TB.
Case Description
60 year old female with history of hypertension, Type 2 Diabetes, ESRD on hemodialysis (began 5 months prior) was found to have persistent hypercalcemia. She was noted to have weight loss and weakness. Her corrected calcium was ~10.7-11.7 mg/dL, phosphorus 5.8 mg/dL, vitamin D 7.8 ng/mL, and iPTH 17 pg/mL during monthly labs. She was instructed to stop her vitamin D supplement and her hemodialysis baths were adjusted; however, hypercalcemia continued. She was referred to her primary care physician for cancer screening. Further workup included mammogram, cologuard, and pap smear. Her mammogram and cologuard were negative. Pap smear was notable for leukoplakia of the cervix and cervical biopsy showed chronic granulomatous inflammation that was positive for acid fast bacilli. Sputum cultures confirmed diagnosis of TB and she was referred to Pulmonology for treatment. Chest X-ray revealed diffuse interstitial prominences with nodular opacities in the bilateral lower lobes. Of note, CT Chest from one year prior revealed consolidative opacities throughout the lungs, with air bronchograms in the left lower lobe, interlobular septal thickening, and groundglass opacities. There was no further work up at that time. She is currently on treatment with rifampin, isoniazid, and ethambutol with improvement of her calcium levels and symptoms. Furthermore, she has plans for a laminectomy due to osseous destruction to her thoracolumbar vertebrae secondary to disseminated TB.
Discussion
This case highlights the importance of keeping high clinical suspicion in ESRD patients with hypercalcemia. It is easy to attribute symptoms such as weight loss, weakness, or hypercalcemia to ESRD, however this particular case resulted in the diagnosis of disseminated TB. ESRD patients are at an increased risk of both cancer and TB, and therefore a broad differential must be kept in mind when presented with hypercalcemia.