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Rifampicin-induced adrenal crisis in a patient with tuberculosis: a therapeutic challenge
  1. Nicholas Denny,
  2. Sarika Raghunath,
  3. Praveen Bhatia,
  4. Muntasir Abdelaziz
  1. Department of Respiratory Medicine, Tameside General Hospital, Ashton-under-Lyne, UK
  1. Correspondence to Dr Nicholas Denny, scat3660{at}


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.

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  • Contributors ND contributed to design of and drafted the initial manuscript. ND and MA were involved in acquisition of the data. All the authors were involved in critical revision of the manuscript and final version for publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.