Successful Treatment of Tuberculosis Combined With Rifampicin Induced Interstitial Nephritis: A Case Report

Abstract

A 61-year-old man was admitted to our hospital on September 2021 because of a three-month history of fatigue, night sweats, and weight loss. The patient had been diagnosed with organized pneumonia and was treated with methyl prednisolone at a local hospital. One week before presentation to our hospital, he had developed fever, cough, sputum and shortness of breath. Upon admission to our hospital, sputum acid-fast resistant bacteria (ARB) and urine ARB were positive and mycobacterium tuberculosis was cultured. With the diagnosis of drug-sensitive pulmonary and urinary tuberculosis, treatment consisting of isoniazid, rifampicin, ethambutol and pyrazinamide was started. After two months, his symptoms had not improved and he developed nausea and vomiting. At the next visit to our hospital, his renal function tests were further increased. He was taken for emergency dialysis. Diagnosis of interstitial nephritis was made by kidney biopsy, which was considered to have developed due to the use of rifampicin. Rifampicin was discontinued and methyl prednisolone was added. The new drug regimen was arranged as isoniazid, moxifloxacin, ethambutol, pyrazinamide and cycloserine. Cycloserine was discontinued due to tremors and prothionamide was started. When drug-induced hepatitis developed, his subsequent treatment was changed to isoniazid, levofloxacin, ethambutol, and pyrazinamide. The patient was treated with methyl prednisolone for two months. Currently, he has been taking the treatment stated above for 4 months without any problems and it is scheduled to be completed in 12 months.