Tuberculous granulomatous inflammation of parathyroid adenoma manifested as primary hyperparathyroidism: A case report and a review of the literature

Abstract

Tuberculosis of the thyroid gland is rare, and tuberculous granulomatous inflammation of the parathyroid glands is even rarer. The present study reports a rare case of primary hyperparathyroidism caused by tuberculous granulomatous inflammation. A 58-year-old female patient presented with generalized body pain persisting for 1 year. She had a history of recurrent renal stones (>20 times) and an incidental finding of multinodular goiter involving the parathyroid on neck ultrasound. A blood analysis revealed elevated levels of serum calcium (11.26 mg/dl) and parathyroid hormone (154.7 pg/ml). The patient underwent the resection of the affected left thyroid lobe under general anesthesia. A histopathological examination revealed parathyroid adenoma with caseating granulomatous inflammation involving the adenoma with focal lymphocytic thyroiditis of the left thyroid gland. Although granulomatous parathyroid disease with parathyroid adenoma causing hypercalcemia is an extremely rare event, it can occur. The treatment of choice is surgical resection.

Keywords: caseating granulomatous inflammation; extrapulmonary tuberculosis; hypercalcemia; parathyroid adenoma; primary hyperparathyroidism; tuberculosis.

Figure 1

Ultrasound image illustrating a multinodular goiter with mildly suspicious, bilateral homogeneous echo texture nodules measuring 4 mm within the right thyroid gland. The left thyroid gland exhibited a non-suspicious (TR2) nodule measuring 13x9x8 mm and a mildly suspicious (TR3) nodule measuring 10x9x7 mm. Below the left lower pole of the thyroid gland, a solid hypoechoic hypovascular nodule of 20x7 mm was observed, which suggested a parathyroid adenoma. No notable cervical lymphadenopathy was observed.

Figure 2

The section of the specimen (stained with eosin and hematoxylin) under microscopy illustrates a parathyroid adenoma containing well-defined epithelioid granulomas (arrow) with areas of caseating necrosis (star).