Treatment for tuberculosis in a patient with Dubin-Johnson syndrome

Abstract

Dubin-Johnson syndrome (DJS) is an autosomal recessive disorder characterised by conjugated hyperbilirubinemia resulting from mutations of ABCC2/MRP2 gene. The beneficial effects of ursodeoxycholic acid (UDCA) and rifampicin were found to be complementary in the treatment of cholestatic liver disease secondary to DJS. We present a case of a young woman with tubercular meningitis. She was started on modified antitubercular therapy in view of conjugated hyperbilirubinemia. However, reinitiation of rifampicin resulted in redevelopment of jaundice. Liver biopsy was suggestive of DJS. The patient was started on rifampicin along with UDCA. There was improvement in hyperbilirubinemia and a full course of antituberculous therapy without further worsening of the disorder was possible. This is a rare case of DJS with tuberculosis, showing beneficial effects of rifampicin and UDCA combination therapy, which so far has been considered doubtful. It is uncertain what the level of efficacy of therapy is in various MRP2 gene mutations.

Severe Course of Lung Abscess due to Multidrug Resistant Proteus mirabilis and Escherichia coli

“…Rapid molecular diagnostic techniques can identify microorganisms and antibiotic resistance faster than conventional culture methods. 5 Escalation and de-escalation strategies improve antibiotic treatment in the intensive care unit. Antibioticresistant bacteria should be considered in community-acquired infections, especially in children with underlying conditions.…”

Jaundice During Antitubercular Treatment: Not Only Drug-induced Liver Injury

“…3 It is a benign disorder and does not require specific therapy. To date, 2 patients 4,5 with combined TB and DJS have been reported, and conjugated bilirubin elevated after rifampin introduction was observed. It may result from the increased expression of MRP3.…”