Inadvertent haemodialysis in a pulmonary tuberculosis patient with hypercalcaemia.

Dear Editor, Malaysia is a country with an intermediate burden of tuberculosis (TB) with a prevalence of 121 cases per 100,000 population per year.1 TB usually presents with fever, chronic cough, weight loss and lack of appetite, dypsnoea and night sweats. Hypercalcaemia is a well known but rare complication of TB. The prevalence of hypercalcaemia in patients with untreated TB varies widely between countries. In Malaysia, the rate is in the range of 2.3% to 27.5%.2,3 The development of hypercalcaemia depends on the total intake of calcium and vitamin D, the amount of sun exposure, degree of renal impairment and extra renal production of vitamin D by the alveolar T-lymphocytes and macrophages.4 The intensity of each of these factors play a role as not all patients with similar factors will go on to develop hypercalcaemia. The production of vitamin D is also related to the degree of immune and infl ammatory response of the host.4 Despite being a nation with an intermediate disease burden of TB; surprisingly, misdiagnosis or delayed diagnosis of TB still occurs. We describe a patient who presented with hypercalcemia and renal failure who underwent haemodialysis. Unfortunately although the hypercalcemia was the clue to the diagnosis of pulmonary TB, this link was missed.