Treatment for tuberculosis in a patient with Dubin-Johnson syndrome.
Dubin-Johnson syndrome (DJS) is an autosomal recessive disorder characterised by conjugated hyperbilirubinemia resulting from mutations of ABCC2/MRP2 gene. The beneficial effects of ursodeoxycholic acid (UDCA) and rifampicin were found to be complementary in the treatment of cholestatic liver disease secondary to DJS. We present a case of a young woman with tubercular meningitis. She was started on modified antitubercular therapy in view of conjugated hyperbilirubinemia. However, reinitiation of rifampicin resulted in redevelopment of jaundice. Liver biopsy was suggestive of DJS. The patient was started on rifampicin along with UDCA. There was improvement in hyperbilirubinemia and a full course of antituberculous therapy without further worsening of the disorder was possible. This is a rare case of DJS with tuberculosis, showing beneficial effects of rifampicin and UDCA combination therapy, which so far has been considered doubtful. It is uncertain what the level of efficacy of therapy is in various MRP2 gene mutations.
Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India.
Meena
M
Alpana
Department of Medicine, Maulana Azad Medical College, New Delhi, India.
Mradul Kumar
MK
Daga
Department of Medicine, Maulana Azad Medical College, New Delhi, India.
Sunita
S
Aggarwal
Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India.
Anand
A
Nidhi
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D007566:Jaundice, Chronic Idiopathic / Q000150:complications* / Q000188:drug therapy*; D000089762:Multidrug Resistance-Associated Protein 2; D012293:Rifampin / Q000627:therapeutic use; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000188:drug therapy*; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
C000715087:ABCC2 protein, human; D000995:Antitubercular Agents; D002756:Cholagogues and Choleretics; D000089762:Multidrug Resistance-Associated Protein 2; D014580:Ursodeoxycholic Acid; D007538:Isoniazid; D012293:Rifampin