Addison's Disease Caused by Tuberculosis with Atypical Hyperpigmentation and Active Pulmonary Tuberculosis

Abstract

We herein report a case of Addison's disease caused by tuberculosis characterized by atypical hyperpigmentation, noted as exacerbation of the pigmentation of freckles and the occurrence of new freckles, that was diagnosed in the presence of active pulmonary tuberculosis. The clinical condition of the patient was markedly ameliorated by the administration of hydrocortisone and anti-tuberculosis agents. When exacerbation of the pigmentation of the freckles and/or the occurrence of new freckles are noted, Addison's disease should be considered as part of the differential diagnosis. In addition, the presence of active tuberculosis needs to be assumed whenever we treat patients with Addison's disease caused by tuberculosis, despite its rarity.

Tuberculous Addison’s disease with increased hydrocortisone requirements due to administration of rifampicin

“…There have been several case reports in which a patient with tuberculous Addison’s disease presented with worsening symptoms of adrenal insufficiency after administration of rifampicin. One patient was first given 20 mg HC daily, but this dosage was not changed after rifampicin administration,7 and one patient presented with symptoms of adrenal insufficiency induced by rifampicin; however, this report did not describe the dose of glucocorticoid prescribed after rifampicin administration 8. Ultimately, one patient developed adrenal crisis after rifampicin administration and was subsequently treated with 60 mg HC daily 9.…”

Endocrine and Metabolic Manifestations of Tuberculosis

“…TB accounts for about 7-20% of cases of Addison's disease. 9 Five percent of the patients with disseminated TB develop clinically significant adrenal insufficiency and the incidence is higher in LMICs. 10 Adrenal involvement is reported in 6% of cases in an autopsy series.…”