title: Rifampicin-induced adrenal crisis in a patient with tuberculosis: a therapeutic challenge.
abstract: A 55-year-old Indian man presented with productive cough and a large left pleural effusion. Pleural fluid culture grew Mycobacterium tuberculosis, and he was started on antituberculosis therapy. One week later, the patient presented to hospital with drowsiness, dehydration and hypotension. He was transferred to critical care and only improved after starting hydrocortisone and stopping rifampicin. His short synACTHen test subsequently confirmed primary adrenal insufficiency, and a CT of the abdomen showed bilateral adrenal enlargement. Rifampicin is known to accelerate cortisol metabolism. We report the rare case of a rifampicin-induced adrenal crisis as a first presentation of Addison's disease in a patient with tuberculous infiltration of the adrenal glands.
authors.affiliation: Department of Respiratory Medicine, Tameside General Hospital, Ashton-under-Lyne, UK.
authors.forename: Nicholas
authors.identifier: http://orcid.org/0000-0002-5351-9581
authors.initials: N
authors.lastname: Denny
authors.affiliation: Department of Respiratory Medicine, Tameside General Hospital, Ashton-under-Lyne, UK.
authors.forename: Sarika
authors.initials: S
authors.lastname: Raghunath
authors.affiliation: Department of Respiratory Medicine, Tameside General Hospital, Ashton-under-Lyne, UK.
authors.forename: Praveen
authors.initials: P
authors.lastname: Bhatia
authors.affiliation: Department of Respiratory Medicine, Tameside General Hospital, Ashton-under-Lyne, UK.
authors.forename: Muntasir
authors.initials: M
authors.lastname: Abdelaziz
mesh_terms: D000311:Adrenal Glands / Q000187:drug effects* / Q000503:physiopathology; D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003371:Cough / Q000382:microbiology; D003681:Dehydration; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007022:Hypotension; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010996:Pleural Effusion / Q000150:complications / Q000382:microbiology*; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects*; D012894:Sleep Stages; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000995:Antitubercular Agents; D012293:Rifampin; D006854:Hydrocortisone