Unusual Complication of Multidrug Resistant Tuberculosis

Area of Science:

• Nephrology
• Pharmacology
• Endocrinology

Background:

• Capreomycin is a second-line antitubercular agent.
• Aminoglycosides, including capreomycin, are known for potential nephrotoxicity.
• Multidrug-resistant tuberculosis necessitates the use of drugs like capreomycin.

Observation:

• A 23-year-old female developed carpopedal spasms and paresthesias.
• The patient was on capreomycin for two months for tuberculosis treatment.
• Laboratory findings revealed hypocalcemia, hypomagnesemia, hypokalemia, hyponatremia, and hypochloremic metabolic alkalosis with hypercalciuria.

Findings:

• Capreomycin treatment induced a Bartter-like syndrome.
• Electrolyte abnormalities and metabolic alkalosis were corrected upon capreomycin discontinuation and supplementation.
• Vitamin D and PTH levels were normal, ruling out primary endocrine causes.

Implications:

• Aminoglycoside-induced renal tubular dysfunction can manifest as Bartter-like syndrome.
• Prompt recognition and management of dyselectrolytemia are crucial in patients receiving aminoglycosides.
• This case underscores the need for vigilant monitoring of renal function and electrolytes.