Case Report: Rhabdomyolysis and Flare-up of Lupus Erythematosus as Complications of Tuberculostatic Drug Therapy in a Pakistani Patient with Mycobacterium africanum Infection
Introduction: Infections due to mycobacterium tuberculosis remain a major public health concern and in many parts of the world, tuberculosis is still one of the leading causes of death. Major adverse reactions to standard anti-tuberculosis drugs can cause significant morbidity and compromise treatme...
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| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224005861 |
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| Summary: | Introduction: Infections due to mycobacterium tuberculosis remain a major public health concern and in many parts of the world, tuberculosis is still one of the leading causes of death. Major adverse reactions to standard anti-tuberculosis drugs can cause significant morbidity and compromise treatment regimens.1 Case Report: We present the case of a 48-year-old female Pakistani patient who was admitted for further investigation of pulmonary consolidations confirmed on CT scan (Figure 1). Since 2021, the patient had been diagnosed with systemic lupus erythematosus (SLE) with dialysis-dependent end stage renal disease due to lupus nephritis. She was on treatment with low-dose oral corticosteroids and hydroxychloroquine for maintenance therapy. Initially assumed to be SLE associated pulmonary manifestations, the diagnosis of a tuberculosis lung disease could finally be confirmed and treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was started.Figure 1: bipulmonary consolidations on CT scanWhile on tuberculostatic therapy, the patient developed a rhabdomyolysis with a profound increase of myoglobin and creatine kinase (CK) levels (Figure 2). The patient complained of pronounced myopathy with adynamia, muscle weakness and muscle pain. A lupus flare was confirmed by autoimmune hemolytic anemia, thrombocytopenia (Figure 2) and decline of complement factors C3 and C4.Figure 2: Rhabdomyolysis and lupus flare under tuberculostatic therapy Discussion: In recent years lupus erythematosus was identified as a risk factor for pulmonary and extrapulmonary tuberculosis1. Balancing tuberculostatic and immunosuppressive medication can be difficult, as tuberculosis as well as anti-mycobacterial treatment can result in a flare-up of autoimmune disease2. In the case of our patient, we attribute the rhabdomyolysis and lupus flare to the tuberculostatic medication. However, the flare up of the underlying autoimmune disease due to the tuberculosis infection itself would still be an alternative explanation. After discontinuation of tuberculostatic drugs, CK- and myoglobin levels normalized and with high dose oral corticosteroids the manifestations of the lupus flare subsided. Treatment was continued according to new WHO guidelines3 with bedaquiline, pretomanid, linezolid and moxifloxacin and well tolerated. Conclusion: Severe adverse reactions to standard tuberculostatic treatment can lead to increased morbidity. In patients with concomitant autoimmune diseases, regular clinical and laboratory monitoring are essential to promptly detect flares and other serious adverse reactions. |
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| ISSN: | 1201-9712 |