[69 years old male patient, with impairment of physical condition, hyperpigmentation, cutaneous lesion and a deficient response to treatment].
We submit the case of a male patient, suffering from a tuberculous ethiology adrenal primary insufficiency, showing a dermal lesion, in which necrotizing granulomas were found, and from which bacterial culture growth yielded mycobacterium bovis. Given the clinical findings, and awaiting for the bacterial culture result, a triple treatment with tuberculostatics was started, but had to be discontinued because of hepatic toxicity. After culture of cutaneous biopsy yielded micobaterium tuberculosis, treatment with streptomycin, rifampicin and etambutol was restarted. Three weeks later, in spite of increasing hydrocortisone dose to 40 mg, adrenal insufficiency reappeared. Under the circumstances, we chose to continue rifampicin and double hydrocortisone dose. The case is of concern because of the concurrency of three nowadays infrequent disorders: tuberculous ethiology adrenal insufficiency, cutaneous tuberculosis due to mycobacterium bovis and primary adrenal insufficiency due to rifampicin treatment, the latter resolved after increasing hydrocortisone dose.
Prieto de Paula
J M
JM
Servicios de Medicina Interna, Complejo Hospitalario de Palencia, Burgos, Spain. jmpripaula@yahoo.es
Aliaga Y Montilla
M A
MA
Alonso Fernández
J I
JI
Martín Serradilla
J I
JI
Relea Sarabia
A
A
Villamandos Nicás
V
V
D000224:Addison Disease / Q000139:chemically induced / Q000209:etiology*; D000307:Adrenal Gland Diseases / Q000150:complications* / Q000188:drug therapy; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000009:adverse effects; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology; D008297:Male; D009163:Mycobacterium bovis; D012293:Rifampin / Q000009:adverse effects; D014382:Tuberculosis, Cutaneous / Q000150:complications* / Q000188:drug therapy; D014383:Tuberculosis, Endocrine / Q000150:complications* / Q000188:drug therapy
D000904:Antibiotics, Antitubercular; D012293:Rifampin