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ISSN: 2329-9126
Journal of General Practice
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Scleral and Body Hyperpigmentation in Disseminated Tuberculosis with Adrenal Insufficiency (Addisons Disease)

Muzamil Latief1, Waseem Raja2*, Manzoor Parry1 and Ravi Rao1
1Department of Internal Medicine, University Ambala, Maharishi Markandeshwar, Haryana
2Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Jammu & Kashmir, India
*Corresponding Author : Waseem Raja
Department of Internal Medicine
Sher-i-Kashmir Institute of Medical Sciences
Jammu & Kashmir, India
Tel: +918222800676
E-mail: [email protected]
Received: February 24, 2016 Accepted: March 02, 2016 Published: March 11, 2016
Citation: Latief M (2016) Scleral and Body Hyperpigmentation in Disseminated Tuberculosis with Adrenal Insufficiency (Addison’s Disease). J Gen Practice 4:i002. doi: 10.4172/2155-6105.1000i002
Copyright: © 2016 Latief M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Clinical Image
A 25 years old gentleman was diagnosed with Pulmonary Tuberculosis 1 year back and started on Anti Tuberculosis Treatment (ATT) 4 Drugs (Isoniazid, Rifampin, Pyrazinamide and Ethambutol). He took these medications for a period of 6 weeks and stopped the medication on his own. He never returned to any healthcare facility until he presented to us with complaints of weight loss for last 6 months, progressive skin hyperpigmentation and nausea for 4 weeks before presenting to us. On presentation, there was diffuse hyperpigmentation of whole body including buccal mucosa, tongue and sclera (Figures 1-3). He was in hypotension with tachycardia. Investigations revealed hyponatremia with random serum cortisol 8 nmol/L and Post ACTH stimulation, cortisol levels at 30 minutes and 60 minutes were <11 nmol/L. Serum ACTH levels were high. Abdominal Imaging revealed bilateral Adrenal Enlargement. Patient was started on IV fluids and IV steroids (Hydrocortisone 50 mg 6 hourly) and Anti-Tuberculosis Treatment (Isoniazid, Rifampin, Pyrazinamide, Ethambutol and Streptomycin). His hemodynamic parameters improved during hospital stay, nausea and anorexia settled. Subsequently patient was discharged on oral steroids Hydrocortisone 20 mg twice a day and Fludricortisone 100 mcg/day and made to continue ATT. Patient is doing well on follow up.

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Review summary

  1. Tianna Wells
    Posted on Oct 17 2016 at 5:04 pm
    The publication of clinical images is a very novel and rewarding concept. It not only enhances the clinical importance of the article but also helps in diagnosis of similar diseases in future. The present article educates us regarding the possible consequences of discontinuation of ATT therapy in tuberculosis patients as well as diagnosis and treatment of Addison’s disease.
 

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