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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 4  |  Page : 742-743
Parathyroid gland tuberculosis associated with secondary hyperparathyroidism in hemodialysis patient


Service of Nephrology, Hemodialysis and Kidney Transplantation, Military Hospital, Mohammed V, Rabat, Morocco

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Date of Web Publication26-Jun-2010
 

How to cite this article:
Kabbaj DE, Oualim Z. Parathyroid gland tuberculosis associated with secondary hyperparathyroidism in hemodialysis patient. Saudi J Kidney Dis Transpl 2010;21:742-3

How to cite this URL:
Kabbaj DE, Oualim Z. Parathyroid gland tuberculosis associated with secondary hyperparathyroidism in hemodialysis patient. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Sep 21];21:742-3. Available from: http://www.sjkdt.org/text.asp?2010/21/4/742/64665
To the Editor,

Tuberculosis associated with adenoma of the parathyroid gland is rare. Few reported cases were about tuberculosis associated with pri­mary hyperparathyroidism. [1],[2] We encountered a chronic hemodialysis patient who was ope­rated on for resection of a parathyroid ade­noma with signs of secondary hyperparathyroi­dism. The histopathological exam of the resec­ted tissue revealed the presence of epithelioid granuloma with caseous necrosis. A 49-year­old female with chronic hemodialysis for ten years had biochemical findings and skeletal sur­vey suggestive of secondary hyperparathyroi­dism with normal level of serum calcium, ele­vated serum phosphate, and elevated serum parathormon at 1200 pg/mL not responding to medical treatment. She underwent cervical ex­ploration and excision of 7/8 parathyroid gland. There were no visible lymph nodes in the pa­ratracheal and lateral cervical groups. The his­topathological examination revealed the fea­tures of parathyroid adenoma with many foci of epithelioid granulomas with caseous necro­sis [Figure 1] and [Figure 2]. However, the patient did not have any symptoms suggestive of tuber­culosis such as generalized body ache, fever, chronic cough, or significant weight loss. Exa­mination of the neck did not detect any lump or cervical lymphadenopathy. Computerized to­mography of the neck and thorax did not dis­close any nodes or other lesions. Tuberculosis prevalence is high among adults in Morocco, and the immuno-compromised state in patients with end-stage renal disease predisposes to the extrapulomnary tuberculosis. [3],[4] A 4-drug anti­tuberculosis regimen including isoniazid, ri­fampin, pyrazinamide and Ethambutol was pres­cribed. Half dose of Isoniazid (2.5 mg/kg/day) and full dose of rifampicin (10 mg/kg/day) were administered for 12 months in addition to a half dose of pyrazinamid (15 mg/kg/day) and adapted dose of ethambutol (7.5 g/kg/day) con­tinued for only two months. The evolution of the tuberculosis was favorable but the patient died 4 months later in unspecified circums­tances.

Our patient had secondary hyperparathyroi­dism and incidentally found tuberculosis in the parathyroid tissue.

 
   References Top

1.Kar DK, Agarwal G, Mehta B, et al. Tuberculous granulomatous inflammation associated with adenoma of parathyroid gland manifesting as primary hyperparathyroidism. Endocr Pathol 2001;12(3):355-9.  Back to cited text no. 1      
2.Jacob PM, Sukumar GC, Nair A, Thomas S. Parathyroid adenoma with necrotizing granulo­matous inflammation presenting as primary hyperparathyroidism. Endocr Pathol. 2005;16 (2):157-60.  Back to cited text no. 2      
3.Lundin AP, Adler AJ, Berlyne GM, Friedman EA. Tuberculosis in patients undergoing main­tenance hemodialysis. Am J Med 1979;67:597­-602  Back to cited text no. 3      
4.Abdelrahman M, Sinha AK, Karkar A. Tuber­culosis in end-stage renal disease patients on hemodialysis. Hemodial Int 2006;10(4):360-4  Back to cited text no. 4      

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Correspondence Address:
Driss El Kabbaj
Service of Nephrology, Hemodialysis and Kidney Transplantation, Military Hospital, Mohammed V, Rabat
Morocco
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PMID: 20587885

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