A case of peritoneal dialysis involving seizures and unconsciousness accompanied by severe hypertension during anti‒tuberculosis treatment

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  • Kondo Jiro
    Department of Nephrology and Rheumatology, Kagawa Prefectural Central Hospital
  • Ujike Haruyo
    Department of Nephrology and Rheumatology, Kagawa Prefectural Central Hospital
  • Yamasaki Yasushi
    Department of Nephrology and Rheumatology, Kagawa Prefectural Central Hospital
  • Akashi Yoshihiro
    Department of Internal Medicine, Utazu Hospital

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Other Title
  • リファンピシン投与を契機に重症高血圧が生じ，リファブチンへの変更にて軽快した腹膜透析患者の1例
  • リファンピシン トウヨ オ ケイキ ニ ジュウショウ コウケツアツ ガ ショウジ,リファブチン エ ノ ヘンコウ ニテ ケイカイ シタ フクマク トウセキ カンジャ ノ 1レイ

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Abstract

<p>A 33‒year‒old female, who had been on peritoneal dialysis for 6 years because of chronic renal failure secondary to recurrent rapidly progressive nephritis, presented with fever and a cough, which had persisted for over a month. She had a history of hypertension and mental retardation. Chest computed tomography showed right‒sided lymphadenopathy. Her sputum tuberculosis polymerase chain reaction test was positive for Mycobacterium tuberculosis. She was transferred to our hospital to receive treatment for pulmonary tuberculosis. She was treated with isoniazid, rifampicin (RFP), ethambutol, and pyrazinamide. After the administration of these drugs, her systolic blood pressure increased to 200 mmHg on day 5. She experienced seizures and disturbed consciousness on day 6 and was transferred to the intensive care unit. An intravenous anti‒hypertensive drug improved her consciousness level and respiration although her blood pressure continued to be very high. An interaction between RFP and her anti‒hypertensive drugs was suspected. Immediately after RFP was switched to rifabutin (RBT), her blood pressure decreased and came under control. She was discharged home on day 30. Cytochrome P (CYP) activity is strongly induced by RFP, which may have resulted in the anti‒hypertensive drugs being metabolized quicker, reducing their effectiveness. RBT is known to induce CYP activity less than RFP. The administration of anti‒tuberculosis drugs to patients on renal replacement therapy should be performed carefully because drug interactions can occur.</p>

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