Meuthen I, Kirsch L, Saborowski F
Medizinische Klinik, Städtisches Krankenhaus Köln-Holweide.
Dtsch Med Wochenschr. 1991 Jun 7;116(23):899-902. doi: 10.1055/s-2008-1063695.
A 57-year-old man with a history of tuberculosis (TB of the knee-joint 44 years ago and open pulmonary TB six months ago with poor patient drug compliance) had lost 10 kg in weight during the preceding six months. In addition, firm lymph-node swellings with redness of the overlying skin and a skin fistula developed on the right side of the neck. There was mild hypercalcaemia (albumin-corrected serum calcium concentration 2.59 mmol/l) and hyperphosphataemia (2.0 mmol/l) with low-normal serum concentrations of parathormone and of 25-hydroxy-vitamin D3 (14 ng/ml). Serum 1,25-dihydroxy-vitamin D3 concentration was reduced (16 ng/l). The activity of osseous isoenzyme of alkaline phosphatase was normal (19 U/l) and skeletal scintigraphy revealed no abnormality. The cervical lymph-nodes were excised (histology: active caseous lymph-node TB). Tuberculostatic treatment was begun with daily doses of 0.3 g isoniazid, 0.45 g rifampicin, 1.2 g ethambutol and 1.5 g pyrazinamide. Serum calcium concentration rose to 3.22 mmol/l (albumin-corrected) in the first two weeks, even though the patient was on a low-calcium diet. The various concentrations subsequently decreased, but remained slightly elevated throughout the period of observation (11 weeks). This is thus a case of TB-associated hypercalcaemia which was not caused by 1,25-dihydroxy-vitamin D3 or bone destruction.
一名57岁男性，有结核病史（44年前膝关节结核，6个月前开放性肺结核且患者药物依从性差），在过去6个月体重减轻了10公斤。此外，右侧颈部出现了质地坚硬的淋巴结肿大，其上覆皮肤发红并有皮肤瘘管形成。存在轻度高钙血症（白蛋白校正血清钙浓度2.59 mmol/L）和高磷血症（2.0 mmol/L），甲状旁腺激素和25-羟维生素D3血清浓度处于低正常范围（14 ng/ml）。血清1,25-二羟维生素D3浓度降低（16 ng/L）。碱性磷酸酶骨同工酶活性正常（19 U/L），骨骼闪烁扫描未显示异常。切除了颈部淋巴结（组织学检查：活动性干酪样淋巴结结核）。开始抗结核治疗，每日剂量为异烟肼0.3 g、利福平0.45 g、乙胺丁醇1.2 g和吡嗪酰胺1.5 g。尽管患者采用低钙饮食，但血清钙浓度在最初两周升至3.22 mmol/L（白蛋白校正）。随后各种浓度下降，但在整个观察期（11周）内仍略有升高。因此，这是一例与结核相关的高钙血症病例，并非由1,25-二羟维生素D3或骨质破坏引起。
