An unusual cause of encephalopathy with renal failure in a patient with treated HCV cirrhosis.

A 63-year-old teetotaller male, previously treated for hepatitis C-related compensated cirrhosis, presented with acute-onset encephalopathy with no focal neurological deficit and stable vitals. Investigations revealed elevated serum creatinine (2.94 mg/dL), hypercalcemia, hypophosphatemia, and high serum PTH levels. He was diagnosed with right parathyroid adenoma (1.3×1.2×0.7 cm) with the help of a neck ultrasound. His encephalopathy and renal failure persisted despite adequate IV fluids, calcitonin, and bisphosphonates. Urgent hemi-parathyroidectomy was performed on day four, following which he recovered completely.