Rifabutin-Induced SIADH and Leucopenia in a Renal Transplant Recipient with Genitourinary Tract Tuberculosis: A Case Report and Review of the Literature
Tuberculosis (TB) infection of the genitourinary tract (GU TB) is rare in renal transplant recipients, with only a few published case series. GU TB is difficult to diagnose with or without immunosuppression but must always be suspected in any patient with unexplained sterile pyuria. As GU TB is asso...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2022-08-01
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| Series: | Case Reports in Nephrology and Dialysis |
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| Online Access: | https://www.karger.com/Article/FullText/525921 |
| _version_ | 1811261881106563072 |
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| author | Maha Mohamed Muhammad Waseem Athar Yaasir Mamoojee Alison Brown Frances Dowen Jim Macfarlane |
| author_facet | Maha Mohamed Muhammad Waseem Athar Yaasir Mamoojee Alison Brown Frances Dowen Jim Macfarlane |
| author_sort | Maha Mohamed |
| collection | DOAJ |
| description | Tuberculosis (TB) infection of the genitourinary tract (GU TB) is rare in renal transplant recipients, with only a few published case series. GU TB is difficult to diagnose with or without immunosuppression but must always be suspected in any patient with unexplained sterile pyuria. As GU TB is associated with graft rejection, prompt diagnosis and treatment are vital. Treatment is challenging, as rifampicin, the most effective drug used to treat tuberculosis, is a significant inducer of cytochrome P-450 3A metabolism, with the potential to cause significant reductions in the serum levels of calcineurin inhibitors. For this reason, rifabutin, a weaker cytochrome P-450 3A inducer, with similar efficacy against TB, is sometimes used as an alternative to rifampicin in transplant recipients. We present a renal transplant patient diagnosed with GU TB, treated with a regime containing rifabutin, who subsequently developed profound hyponatremia and leucopenia. Serum and urine biochemistry was consistent with a diagnosis of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both SIADH and leucopenia resolved with rifabutin cessation. This is the first report of biochemically proven, idiosyncratic SIADH and leucopenia associated with the use of rifabutin in the treatment of GU TB in a renal transplant recipient. |
| first_indexed | 2024-04-12T19:13:52Z |
| format | Article |
| id | doaj.art-9c569c0c456f483aa56bd4fd4f01b064 |
| institution | Directory Open Access Journal |
| issn | 2296-9705 |
| language | English |
| last_indexed | 2024-04-12T19:13:52Z |
| publishDate | 2022-08-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Nephrology and Dialysis |
| spelling | doaj.art-9c569c0c456f483aa56bd4fd4f01b0642022-12-22T03:19:48ZengKarger PublishersCase Reports in Nephrology and Dialysis2296-97052022-08-0112211712310.1159/000525921525921Rifabutin-Induced SIADH and Leucopenia in a Renal Transplant Recipient with Genitourinary Tract Tuberculosis: A Case Report and Review of the LiteratureMaha Mohamed0Muhammad Waseem Athar1Yaasir Mamoojee2Alison Brown3Frances Dowen4Jim Macfarlane5Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, United KingdomRespiratory Medicine, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Newcastle, United KingdomEndocrine Medicine, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Newcastle, United KingdomRenal Services, Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle, United KingdomRenal Services, Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle, United KingdomRespiratory Medicine, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Newcastle, United KingdomTuberculosis (TB) infection of the genitourinary tract (GU TB) is rare in renal transplant recipients, with only a few published case series. GU TB is difficult to diagnose with or without immunosuppression but must always be suspected in any patient with unexplained sterile pyuria. As GU TB is associated with graft rejection, prompt diagnosis and treatment are vital. Treatment is challenging, as rifampicin, the most effective drug used to treat tuberculosis, is a significant inducer of cytochrome P-450 3A metabolism, with the potential to cause significant reductions in the serum levels of calcineurin inhibitors. For this reason, rifabutin, a weaker cytochrome P-450 3A inducer, with similar efficacy against TB, is sometimes used as an alternative to rifampicin in transplant recipients. We present a renal transplant patient diagnosed with GU TB, treated with a regime containing rifabutin, who subsequently developed profound hyponatremia and leucopenia. Serum and urine biochemistry was consistent with a diagnosis of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both SIADH and leucopenia resolved with rifabutin cessation. This is the first report of biochemically proven, idiosyncratic SIADH and leucopenia associated with the use of rifabutin in the treatment of GU TB in a renal transplant recipient.https://www.karger.com/Article/FullText/525921hyponatremialeucopeniarenal transplantrifabutintuberculosis |
| spellingShingle | Maha Mohamed Muhammad Waseem Athar Yaasir Mamoojee Alison Brown Frances Dowen Jim Macfarlane Rifabutin-Induced SIADH and Leucopenia in a Renal Transplant Recipient with Genitourinary Tract Tuberculosis: A Case Report and Review of the Literature Case Reports in Nephrology and Dialysis hyponatremia leucopenia renal transplant rifabutin tuberculosis |
| title | Rifabutin-Induced SIADH and Leucopenia in a Renal Transplant Recipient with Genitourinary Tract Tuberculosis: A Case Report and Review of the Literature |
| title_full | Rifabutin-Induced SIADH and Leucopenia in a Renal Transplant Recipient with Genitourinary Tract Tuberculosis: A Case Report and Review of the Literature |
| title_fullStr | Rifabutin-Induced SIADH and Leucopenia in a Renal Transplant Recipient with Genitourinary Tract Tuberculosis: A Case Report and Review of the Literature |
| title_full_unstemmed | Rifabutin-Induced SIADH and Leucopenia in a Renal Transplant Recipient with Genitourinary Tract Tuberculosis: A Case Report and Review of the Literature |
| title_short | Rifabutin-Induced SIADH and Leucopenia in a Renal Transplant Recipient with Genitourinary Tract Tuberculosis: A Case Report and Review of the Literature |
| title_sort | rifabutin induced siadh and leucopenia in a renal transplant recipient with genitourinary tract tuberculosis a case report and review of the literature |
| topic | hyponatremia leucopenia renal transplant rifabutin tuberculosis |
| url | https://www.karger.com/Article/FullText/525921 |
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