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Kilinc S, Bostan O, Erol M, Erturk S, Dilek D, Yigit O. Successful management with bisphosphonate treatment in a child with tuberculosis-associated hypercalcemia. North Clin Istanb 2020; 7:411-4. [PMID: 33043270 DOI: 10.14744/nci.2019.14890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 05/21/2019] [Indexed: 11/20/2022] Open
Abstract
Hypercalcemia is a common metabolic abnormality in children and generally occurs due to hyperparathyroidism, vitamin D toxicity, some genetic disorders and malignant diseases. Granulomatous diseases are a rare cause of hypercalcemia in children, which are usually mild and asymptomatic. Severe hypercalcemia in granulomatous diseases has also been reported in the literature. Here, we report a child presenting with severe hypercalcemia secondary to miliary tuberculosis with successful management with bisphosphonate treatment. Increased 1,25(OH)2D3 synthesis by activated macrophages in the granuloma tissue is the major mechanism of hypercalcemia in tuberculosis.
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Dayal D, Didel SR, Agarwal S, Sachdeva N, Singh M. Acute Hypercalcaemia and Hypervitaminosis D in an Infant with Extra Pulmonary Tuberculosis. J Clin Diagn Res 2015; 9:SD03-4. [PMID: 26557587 DOI: 10.7860/jcdr/2015/15931.6680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/13/2015] [Indexed: 11/24/2022]
Abstract
In patients with tuberculosis, abnormal extrarenal production of 1,25-dihydroxyvitamin D3 by activated macrophages in granulomatous tissues may result in hypercalcaemia. More commonly reported in adults with active pulmonary tuberculosis, this complication may rarely occur in extrapulmonary tuberculosis, and children. The hypercalcaemia may be precipitated by usually recommended vitamin D and calcium supplementation in patients with tuberculosis. We report here an infant with tubercular meningitis who developed hypercalcaemia 12 days after starting routine vitamin D and calcium supplementation. This communication highlights the importance of close monitoring of calcium levels in patients with tuberculosis, especially if started on vitamin D and calcium replacement before anti-tubercular therapy.
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Affiliation(s)
- Devi Dayal
- Additional Professor, Pediatric Endocrinology & Diabetes Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Siya Ram Didel
- Registrar, Department of Pediatrics, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Sikha Agarwal
- Registrar, Department of Pediatrics, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Naresh Sachdeva
- Assistant Professor, Department of Endocrinology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Meenu Singh
- Professor, Department of Pediatrics, Postgraduate Institute of Medical Education and Research , Chandigarh, India
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Kojmane W, Chaouki S, Souilmi FZ, Atmani S, Idrissi M, Bouharrou A, Hida M. [Hypercalcemia complicating BCG lymphadenitis: case report]. Arch Pediatr 2015; 22:276-8. [PMID: 25636213 DOI: 10.1016/j.arcped.2014.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 07/19/2014] [Accepted: 12/03/2014] [Indexed: 11/28/2022]
Abstract
One of the side effects of the BCG vaccine is a local infection that may spread to the regional lymph nodes causing lymphadenitis, which can resolve spontaneously without treatment. We report the case of an immunocompetent infant who developed lymphadenitis after administration of the BCG vaccine, complicated with persistent symptomatic hypercalcemia in spite of the usual treatment including corticotherapy. Antituberculous treatment was necessary to reduce this hypercalcemia.
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Affiliation(s)
| | | | | | | | | | | | - M Hida
- CHU Hassan II, 60000 Fez, Maroc
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Verhagen LM, Zomer A, Maes M, Villalba JA, del Nogal B, Eleveld M, van Hijum SAFT, de Waard JH, Hermans PWM. A predictive signature gene set for discriminating active from latent tuberculosis in Warao Amerindian children. BMC Genomics 2013; 14:74. [PMID: 23375113 PMCID: PMC3600014 DOI: 10.1186/1471-2164-14-74] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 01/29/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) continues to cause a high toll of disease and death among children worldwide. The diagnosis of childhood TB is challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. Whereas scientific and clinical research efforts to develop novel diagnostic tools have focused on TB in adults, childhood TB has been relatively neglected. Blood transcriptional profiling has improved our understanding of disease pathogenesis of adult TB and may offer future leads for diagnosis and treatment. No studies applying gene expression profiling of children with TB have been published so far. RESULTS We identified a 116-gene signature set that showed an average prediction error of 11% for TB vs. latent TB infection (LTBI) and for TB vs. LTBI vs. healthy controls (HC) in our dataset. A minimal gene set of only 9 genes showed the same prediction error of 11% for TB vs. LTBI in our dataset. Furthermore, this minimal set showed a significant discriminatory value for TB vs. LTBI for all previously published adult studies using whole blood gene expression, with average prediction errors between 17% and 23%. In order to identify a robust representative gene set that would perform well in populations of different genetic backgrounds, we selected ten genes that were highly discriminative between TB, LTBI and HC in all literature datasets as well as in our dataset. Functional annotation of these genes highlights a possible role for genes involved in calcium signaling and calcium metabolism as biomarkers for active TB. These ten genes were validated by quantitative real-time polymerase chain reaction in an additional cohort of 54 Warao Amerindian children with LTBI, HC and non-TB pneumonia. Decision tree analysis indicated that five of the ten genes were sufficient to classify 78% of the TB cases correctly with no LTBI subjects wrongly classified as TB (100% specificity). CONCLUSIONS Our data justify the further exploration of our signature set as biomarkers for potential childhood TB diagnosis. We show that, as the identification of different biomarkers in ethnically distinct cohorts is apparent, it is important to cross-validate newly identified markers in all available cohorts.
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Affiliation(s)
- Lilly M Verhagen
- Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, PO Box 9101 (internal post 224), Nijmegen, 6500 HB, The Netherlands
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Caracas, Venezuela
| | - Aldert Zomer
- Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, PO Box 9101 (internal post 224), Nijmegen, 6500 HB, The Netherlands
- Centre for Molecular and Biomolecular Informatics, Nijmegen Centre for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mailis Maes
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Caracas, Venezuela
| | - Julian A Villalba
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Caracas, Venezuela
- Lovelace Respiratory Research Institute, Albuquerque, USA
| | - Berenice del Nogal
- Departamento de Pediatría, Hospital de Niños J.M. de los Ríos, Caracas, Venezuela
- Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - Marc Eleveld
- Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, PO Box 9101 (internal post 224), Nijmegen, 6500 HB, The Netherlands
| | - Sacha AFT van Hijum
- Centre for Molecular and Biomolecular Informatics, Nijmegen Centre for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- NIZO food research, Kluyver Centre for Genomics of Industrial Fermentation, Ede, The Netherlands
| | - Jacobus H de Waard
- Laboratorio de Tuberculosis, Instituto de Biomedicina, Caracas, Venezuela
- Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - Peter WM Hermans
- Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, PO Box 9101 (internal post 224), Nijmegen, 6500 HB, The Netherlands
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Amare B, Meseret S, Yabutani T, Moges B, Kassu A. Hypercalcemia in patients with tuberculosis and HIV infections in Northwest Ethiopia. Asian Pacific Journal of Tropical Disease 2012; 2:S629-34. [DOI: 10.1016/s2222-1808(12)60234-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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