Primary hyperparathyroidism and ulcerative colitis in a Nigerian patient

A 50-year-old male was referred to a private clinic based in Lagos, Nigeria for colonoscopy. The procedure was indicated on account of recurrent episodes of mucus and blood in the stools which had lasted about some eighteen months prior to presentation. Five months prior to presentation at the clinic in Nigeria, he made a trip abroad after an episode of sudden onset loss of consciousness whose cause remained undiagnosed. During his trip abroad he had been diagnosed with severe hypercalcemia secondary to primary hyperparathyroidism (PHP). For this he underwent a left inferior parathyroidectomy. The histology showed an adenoma. He had had another episode of hematochezia towards the tail end of his stay abroad and was thus referred for colonoscopy when he arrived back in Nigeria. At presentation, he was noted to have finger clubbing (Grade 2), and third degree hemorrhoidsotherwise he was essentially normal. His serum levels for calcium and phosphorus were within reference ranges at the time of colonoscopy (calcium 8.9 mg/dl (8.6–10.2) and phosphorus 4.4 mg/dl (2.3–4.7)). The colonoscopy revealed prominent features suggestive of left sided ulcerative colitis (UC) extending from the rectal region to the splenic flexure in this patient (Mayo Endoscopic Classification = moderate disease). These findings were corroborated by the histology of the mucosa biopsies. He had been commenced on mesalamine for disease control with remarkable clinical improvement that had brought much relief to his symptoms. He was also being co-