A complex case of clinically diagnosed tuberculosis with hypercalcemia: Not missing the tree for the forest!

The management of tuberculosis in elderly patients often portends unexpected challenges due to multimorbidity. Although tuberculosis in endemic regions such as India may have varied manifestations, this may sometimes be misleading, and physicians may try to explain all symptoms and signs in a patient by tuberculosis, following the classical medical teaching of Occam's razor. Here we describe the case of an elderly gentleman with clinically diagnosed central nervous system tuberculosis and co-existent advanced chronic liver disease. The presence of comorbidities impaired the prescription of usual effective antitubercular therapy. In addition, the patient had hypercalcemia, which could have been mistakenly attributed to tuberculosis, but additional workup revealed a co-existing parathyroid adenoma, whose management plan was deferred.