While coronavirus disease 2019 (COVID‒19) remains a major problem, and the number of hemodialysis patients with COVID‒19 is increasing, few hospitals can receive such patients. Since there are no plumbing facilities in our wards, and performing hemodialysis in isolated ward rooms is difficult, it was necessary to transfer COVID‒19 patients who required hemodialysis from the infectious disease ward to the dialysis unit and prepare multiple dialysis beds. Moreover, because there are no private rooms in our dialysis unit, we constructed green, yellow, and red zones based on the definition of significant contact with infected people and arranged the beds according to the recommendations of the Japanese Society of Dialysis Therapy. We received 17 COVID‒19‒infected hemodialysis patients between April and October 2020, but no nosocomial infections occurred because we took appropriate measures for patient transfers and hemodialysis based on the relevant infection prevention guidelines. In this study, we focused on infection prevention in the dialysis unit and during patient transportation.

An 89‒year‒old male, who had been on maintenance hemodialysis for five months, was referred to our hospital due to anemia, a high CRP level, and hypercalcemia. High serum levels of calcium and 1,25(OH)₂VD, as well as low serum i‒PTH levels, which are unusual in hemodialysis patients, were detected, suggesting ectopic vitamin D activation. Whole‒body computed tomography showed a thickened left pleura, left‒sided pleural effusion, and nodules in both lungs. The bronchial lavage fluid was subjected to an acid‒fast bacterium smear and nucleic acid amplification testing for Mycobacterium tuberculosis, but both produced negative results. A mucosal lesion was present in the left upper bronchus, and caseous granulomas with multinucleated giant cells were found in the lesion during a pathological examination. We diagnosed suspected pulmonary and bronchial tuberculosis and started anti‒tuberculosis drugs as a diagnostic treatment. The patient’s serum calcium and 1,25(OH)₂VD levels returned to near normal within two weeks, and his i‒PTH level increased within five weeks. Chest computed tomography performed at six months after the initiation of anti‒tuberculosis treatment showed partial amelioration of the pulmonary nodules. Calcium metabolic markers are routinely monitored in hemodialysis patients. This case shows another diagnostic role for these markers and suggests that calcium metabolism could be used as an indicator for evaluating the initial therapeutic effects of anti‒tuberculosis drugs.