Hypercalcemia, from the Doctor's Office to the Hospital: The Path to Diagnosis in a Patient with Pott Disease

Introduction: Mycobacterium tuberculosis is the second leading cause of death secondary to an infectious agent worldwide. The primary infection can originate from a pulmonary infection. In some cases, it can spread to the spine, known as Pott's disease. The wide variability of clinical manifestations makes timely diagnosis a challenge. This case describes a patient with CKD who came for consultation to initiate a renal transplant protocol. However, asymptomatic hypercalcemia was detected, resulting in her admission to our service for diagnostic assessment. Case Description: A 32-year-old female with CKD diagnosed 1 year ago, underwent a transplant protocol referral while already on PD. She presented with a history of unintentional weight loss. Lab tests indicated hypercalcemia, hypoalbuminemia, normocytic normochromic anemia, and low PTH levels. Hospitalization was required for peritoneal dialysis adjustments as well as the commencement of the transplant protocol. Thoracoabdominal tomography unveiled hypodense lesions in the spine, prompting further investigation. Bronchoscopy confirmed Mycobacterium bovis, leading to treatment initiation and discharge. A month later, she was readmitted due to catheter dysfunction, and peritoneal fluid cultures tested positive for Mycobacterium. Finally the patient's condition deteriorated, ultimately resulting in her demise. Discussion: Mycobacterium bovis is a significant cause of tuberculosis in both cattle and other mammals, particularly impacting healthcare systems in developing nations. Extrapulmonary tuberculosis affects about 2% of cases, with spinal cord involvement possible through hematological dissemination. Pott's disease presents with constitutional symptoms and progressive back pain. Limited access to diagnostic facilities and the disease's insidious nature complicate timely identification. Patients with CKD undergoing renal replacement therapy face heightened tuberculosis risk, with extrapulmonary presentations more prevalent. Renal involvement, peritonitis in peritoneal dialysis patients, and spinal column infections are notable. Hypercalcemia, driven by granuloma formation due to increased macrophage alpha-1 hydroxylase expression, aids diagnosis, as seen in our patient with Pott's disease.