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Acta Facultatis Medicae Naissensis
2019, vol. 36, br. 3, str. 257-263
jezik rada: engleski
vrsta rada: prikaz slučaja
objavljeno: 09/11/2019
doi: 10.5937/afmnai1903258E
Creative Commons License 4.0
Asimptomatska hiperkalcemija usled kavitarne tuberkuloze pluća - prikaz slučaja
aBabol University of Medical Sciences, Health Research Institute, Infectious Diseases and Tropical Medicine Research Center, Babol, Iran
bKermanshah University of Medical Sciences, Imam Reza Hospital, Clinical Research Development Center, Kermanshah, Iran

e-adresa: drbabazadeh.a@yahoo.com

Sažetak

Hiperkalcemija kod granulomatoznih bolesti poput tuberkuloze (TB) je retka. U radu je opisan slučaj dvadesetjednogodišnjeg muškarca kod koga je nivo kalcijuma u serumu iznosio 14 mg/dL u vreme prijema. Snimanje grudnog koša pokazalo je postojanje šupljina u gornjem delu oba plućna krila, dok je desni lateralni ugao bio zatvoren. Kultura i razmaz sputuma na mikroskopskoj pločici analizirani su na prisustvo bacila Mycobacterium tuberculosis i dobijeni rezultati bili su pozitivni. Kako su vrednosti kreatinina bile povećane, krenulo se sa ispitivanjem bubrežne insuficijencije. Oba patološka mehanizma uticala su na bubrežnu insuficijenciju. Anti-TB terapija uključila je primenu isoniazida u dozi od 5 mg/kg, rifampicina u dozi od 10 mg/kg i pirazinamida u dozi od 20 mg/kg jednom dnevno, u trajanju od dva meseca, a potom je terapija nastavljena isoniazidom i pirazinamidom narednih osam meseci. Pacijent je bio hidriran, primio je diuretike Henleove petlje i prednisolon (20 mg). Nedelju dana nakon uvođenja terapije kortikosteroidima nivoi serumskog kreatinina i kalcijuma su se smanjili (od 4 mg/dL na 2 mg/dL i od 14 mg/dL na 10 mg/dL). Hiperkalcemija, bubrežna insuficijencija, intersticijalni nefritis i proteinurija retko se javljaju kod tuberkuloze pluće, ali ih treba razmatrati kao ozbiljne komplikacije. Stoga, hiperkalcemiju bi trebalo prvo kontrolisati hidratacijom ili steroidnim lekovima uz istovremeno lečenje tuberkuloze, kao i uvođenjem diuretika Henleove petlje i dijetetskog režima.

Ključne reči

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