Publication date: Dec 31, 2025
Miliary tuberculosis (TB) is a rare but severe manifestation in infancy. Hypercalcaemia, well documented in granulomatous diseases like TB and sarcoidosis in adults, is infrequently reported in children. Nephrogenic diabetes insipidus induced by hypercalcaemia is a known complication. A female infant with right-sided neck swelling for 1 month (fine-needle aspiration showed tubercular lymphadenitis), on four-drug anti-tubercular therapy (ATT), admitted with complaints of polyuria, polydipsia and progressive weight loss over the last 2 weeks. Her father was on ATT for pulmonary TB. Investigations revealed hypercalcaemia with suppressed parathyroid hormone, elevated 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, high urinary calcium-to-creatinine ratio and dilute polyuria. Despite adequate hydration and ATT, hypercalcaemia persisted, necessitating corticosteroids, furosemide and a single dose of intravenous zoledronic acid. The child improved significantly with this approach. Hypercalcaemia in paediatric TB, although rare, can be a life-threatening emergency. Prompt recognition and multimodal treatment are crucial steps in management of the condition.
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | Miliary tuberculosis |
| disease | MESH | nephrogenic diabetes insipidus |
| disease | MESH | sarcoidosis |
| disease | MESH | lymphadenitis |
| drug | DRUGBANK | 5-amino-1 3 4-thiadiazole-2-thiol |
| disease | MESH | polyuria |
| disease | MESH | polydipsia |
| disease | MESH | weight loss |
| drug | DRUGBANK | Parathyroid hormone |
| drug | DRUGBANK | Calcium |
| drug | DRUGBANK | Creatinine |
| drug | DRUGBANK | Furosemide |
| drug | DRUGBANK | Zoledronic acid |
| disease | MESH | emergency |
| disease | MESH | Failure to thrive |
| disease | MESH | Hypercalcemia |
| disease | MESH | respiratory infections |