Severe hypercalcemia in elderly patient with asymptomatic pulmonary tuberculosis: a case report


Submitted: 23 August 2022
Accepted: 3 March 2023
Published: 20 March 2023
Abstract Views: 292
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Authors

  • Manoela Barros Geriatric Department, Hospital Santa Casa de Misericórdia de Vitória, Higher School of Science of Santa Casa de Misericórdia de Vitória, ES, Brazil.
  • Sarah Francisco Geriatric Department, Hospital Santa Casa de Misericórdia de Vitória, Higher School of Science of Santa Casa de Misericórdia de Vitória, ES, Brazil.
  • Julia Vieira Geriatric Department, Hospital Santa Casa de Misericórdia de Vitória, Higher School of Science of Santa Casa de Misericórdia de Vitória, ES, Brazil.
  • Rafael Costa Geriatric Department, Hospital Santa Casa de Misericórdia de Vitória, Higher School of Science of Santa Casa de Misericórdia de Vitória, ES, Brazil.
  • Luciene Motta Pathology Department, Hospital Santa Casa de Misericórdia de Vitória, Higher School of Sciences of Santa Casa de Misericórdia de Vitória, ES, Brazil.
  • Cristiano Barros Radiology Department, Hospital Santa Casa de Misericórdia de Vitória, Higher School of Sciences of Santa Casa de Misericórdia de Vitória, ES, Brazil.
  • Decio Sesquim Thoracic Surgery Department, Hospital Santa Casa de Misericórdia de Vitória, Higher School of Sciences of Santa Casa de Misericórdia de Vitória, ES, Brazil.
  • Alessandra Tieppo Geriatric Department, Hospital Santa Casa de Misericórdia de Vitória, Higher School of Science of Santa Casa de Misericórdia de Vitória, ES, Brazil.
  • Caroline Pupim Geriatric Department, Hospital Santa Casa de Misericórdia de Vitória, Higher School of Science of Santa Casa de Misericórdia de Vitória, ES, Brazil.
  • Renato Lirio Morelato Geriatrics residency program, Hospital Santa Casa de Misericórdia de Vitória, Higher School of Science of Santa Casa de Misericórdia de Vitória, ES, Brazil. https://orcid.org/0000-0003-1151-5168

Hypercalcemia presents itself as a challenging disorder in clinical practice, with hyperparathyroidism and malignancies accounting for 90% of the causes. The case report describes a married 78-year-old white rural male worker with low level of education. Given the social isolation brought on by the COVID-19 pandemic, the patient initially received antidepressants for a history of adynamia, muscle weakness, and inappetence for a year. Four months before admission, he had an aggravation of the clinical picture, presenting mental confusion, and becoming dependent for all daily life activities. He was hospitalized with adynamia and intense fatigue, muscle weakness, inappetence with weight loss, splenomegaly and severe hypercalcemia (15.9 mg/mL; corrected by serum albumin - reference value: 8.8 to 10.3 mg/dL) and low parathyroid hormone level. This is a rare case of severe hypercalcemia in an elderly patient with asymptomatic pulmonary tuberculosis with late diagnosis and renal impairment, possibly aggravated by hypercalcemia.


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