Presentation of latent tuberculosis with elevated calcitriol as the first-presenting sign: A case report

Salman J. Khan 1, 2, *, Seemab Sheikh 3, Calvin Yee Fen Lee 4, Husnain Naveed 5, Syeda Fatima Murtaza 1, Sadaf Alam 6, Syed Asjad Tauheed Zaidi 1 and MHD Osama Srour 7

1 Division of Hematology & Oncology, Mayo Clinic, Jacksonville, Florida, USA.
2 Public Health, University of Massachusetts, Amherst, USA.
3 Internal Medicine, Community Health Center, New Britain, Connecticut, USA.
4 University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
5 Shifa College of Medicine, Islamabad, Pakistan.
6 Meritus Health General Hospital Hagerstown, Maryland, USA. 
7 Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.
 
Case Study
World Journal of Advanced Research and Reviews, 2023, 19(03), 1518–1521
Article DOI: 10.30574/wjarr.2023.19.3.1980
 
Publication history: 
Received on 16 August 2023; revised on 27 September 2023; accepted on 29 September 2023
 
Abstract: 
This case report sheds light on an unusual clinical presentation of elevated calcitriol levels and low cholecalciferol, serving as a potential early indicator of latent tuberculosis infection (LTBI). While hypercalcemia, along with the same vitamin D3 picture, has been notably associated with active tuberculosis (TB). What sets this case apart is mildly elevated calcium levels and high calcitriol, all occurring within the context of LTBI. This case report presents a 52-year-old male with mild hypercalcemia and elevated 1,25-dihydroxy vitamin D3 and low 25 hydroxy vitamin D3, revealing a unique biochemical profile. An insignificant chest x-ray with a positive QuantiFERON TB test ultimately confirmed LTBI. The patient was subsequently initiated on a four-month rifampin regimen for LTBI treatment. This case underscores the importance of recognizing elevated calcitriol levels as a potential early sign of latent TB infection.
 
Keywords: 
Latent Tuberculosis; 1,25-dihydroxy vitamin D3; QuantiFERON TB test; low 25 hydroxy vitamin D3; Hypercalcemia; Rifampin
 
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