Chalk and cheese: symptomatic hypocalcaemia during paediatric anti-tuberculous therapy.

Standard anti-tuberculosis therapy may disrupt normal vitamin D metabolism and consequently calcium homeostasis, but this is previously unreported in paediatric patients. We describe two children developed symptomatic hypocalcaemia secondary to hypovitaminosis D, which had been precipitated by rifampicin and isoniazid. The complex relationship between tuberculosis, anti-tuberculosis therapy, vitamin D metabolism and calcium, together with the clinical implications, are discussed.

[1]  B. Milleron,et al.  Vitamin D metabolism by alveolar immune cells in tuberculosis: correlation with calcium metabolism and clinical manifestations. , 1994, The European respiratory journal.

[2]  D. Kwiatkowski,et al.  1,25-Dihydroxyvitamin D3 Induces Nitric Oxide Synthase and Suppresses Growth of Mycobacterium tuberculosis in a Human Macrophage-Like Cell Line , 1998, Infection and Immunity.

[3]  D. Strachan,et al.  Seasonality of tuberculosis: the reverse of other respiratory diseases in the UK. , 1996, Thorax.

[4]  M. Brodie,et al.  Effect of rifampicin and isoniazid on vitamin D metabolism , 1982, Clinical pharmacology and therapeutics.

[5]  M. Erooga,et al.  Calcium Metabolism during Rifampicin and Isoniazid Therapy for Tuberculosis , 1983, Journal of the Royal Society of Medicine.

[6]  R. Brown,et al.  The effect of anti-tuberculosis chemotherapy on vitamin D and calcium metabolism. , 1987, Tubercle.

[7]  M. Brodie,et al.  Effect of isoniazid on vitamin D metabolism and hepatic monooxygenase activity , 1981, Clinical pharmacology and therapeutics.

[8]  R. Wilkinson,et al.  Influence of vitamin D deficiency and vitamin D receptor polymorphisms on tuberculosis among Gujarati Asians in west London: a case-control study , 2000, The Lancet.

[9]  A. S. Douglas,et al.  Does vitamin D deficiency account for ethnic differences in tuberculosis seasonality in the UK? , 1998, Ethnicity & health.

[10]  L. P. Ormerod Rifampicin and isoniazid prophylactic chemotherapy for tuberculosis , 1998, Archives of disease in childhood.

[11]  J. Gerritsen,et al.  Hypercalcaemia in a child with miliary tuberculosis , 1989, European Journal of Pediatrics.

[12]  D. Shingadia,et al.  Diagnosis and treatment of tuberculosis in children. , 2003, The Lancet. Infectious diseases.

[13]  F. Millard,et al.  Risk of tuberculosis in immigrant Asians: culturally acquired immunodeficiency? , 1991, Thorax.

[14]  G. Rook The role of vitamin D in tuberculosis. , 1988, The American review of respiratory disease.

[15]  M. Brodie,et al.  Calcium metabolism during rifampicin and isoniazid therapy for tuberculosis. , 1982, Journal of the Royal Society of Medicine.

[16]  H. Whittle,et al.  Tuberculosis and chronic hepatitis B virus infection in Africans and variation in the vitamin D receptor gene. , 1999, The Journal of infectious diseases.

[17]  W. Perry Calcium metabolism during rifampicin and isoniazid therapy. , 1983, Tubercle.

[18]  B. Milleron,et al.  1,25(OH)2D2 production by T lymphocytes and alveolar macrophages recovered by lavage from normocalcemic patients with tuberculosis. , 1990, The Journal of clinical investigation.