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 hemorrhoids- otherwise 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-managed by an endocrinologist for his associated medical condition.

Though there it has been noted that inflammatory bowel disease incidence is rising in sub-Saharan Africa, it still remains an uncommon finding as is PHP- hence, our interest in this case [1] [2]. The case here presented is rare indeed as a search of scientific literature for such co-existence of PHP and UC yielded very few such similar documentation and none of them were Africans [3] [4] [5]. It is yet to be determined if these isolated cases represent a true relationship between PHP and UC or were mere coincidences.

Keywords: Nigeria, Primary hyperparathyroidism, Ulcerative colitis

1. Annual Incidence of Hyperparathyroidism by country. Extrapolated figures from US Census Bureau, International Data Base 2004. [Available at: http://www.rightdiagnosis.com/h/hyperparathyroidism/stats-country.htm]    
2. Casella G, Villanacci V, Vicentini L, Baldini V, Bassotti G. Primary hyperparathyroidism associated with ulcerative colitis. Inflamm Bowel Dis 2013 Mar;19(3):E40–1.   [CrossRef]   [Pubmed]    
3. Martínez Albaladejo M, Herrero Sagastume V. Primary hyperparathyroidism in a patient with ulcerative colitis and diabetes mellitus. An Med Interna 1989 May;6(5):274–5.   [Pubmed]    
4. Robertson CE, Duff AJ, Munro JF. Hyperparathyroidism with ulcerative colitis. Br J Clin Pract 1981 Oct;35(10):363, 366.   [Pubmed]    
5. Ukwenya AY, Ahmed A, Odigie VI, Mohammed A. Inflammatory bowel disease in Nigerians: still a rare diagnosis? Ann Afr Med 2011 Apr-Jun;10(2):175–9.   [CrossRef]   [Pubmed]