Unusual Complication of Multidrug Resistant Tuberculosis

Abstract

Introduction Capreomycin is a second-line drug often used for multidrug-resistant tuberculosis which can result in nephrotoxic effects similar to other aminoglycosides. We describe a case of capreomycin induced Bartter-like syndrome with hypocalcemic tetany. Case Report 23-year-old female patient presented with carpopedal spasms and tingling sensations in hands. Patient was being treated with capreomycin for two months for tuberculosis. On further investigation, hypocalcemia, hyponatremia, hypomagnesemia, hypokalemia, and hypochloremic metabolic alkalosis were noted. Vitamin D and serum PTH levels were within normal limits. Hypercalciuria was confirmed by urine calcium/creatinine ratio. Calcium, potassium, and magnesium supplementation was given and capreomycin was discontinued. Electrolytes normalized in two days after cessation of capreomycin with no further abnormalities on repeat investigations. Discussion Aminoglycosides can result in renal tubular dysfunction leading to Fanconi syndrome, Bartter syndrome, and distal tubular acidosis. Impaired mitochondrial function in the tubular cells has been hypothesized as the possible cause of these tubulopathies. Acquired Bartter-like syndrome phenotypically resembles autosomal dominant type 5 Bartter syndrome. Treatment consists of correction of electrolyte abnormalities, indomethacin, and potassium-sparing diuretics. Prompt diagnosis and treatment of severe dyselectrolytemia are warranted in patients on aminoglycoside therapy.

Comparison of Serum Potassium, MagnEsium, and Calcium Levels between Kanamycin and Capreomycin-BASEd Regimen-Treated MultiDrug-Resistant TuBerculosis Patients in Bandung (CEASE MDR-TB): A Retrospective Cohort Study

“…We also demonstrated lower serum magnesium levels in the 2 nd month of treatment in the capreomycin-based group; additionally, 2 subjects in this group had severe hypomagnesemia. To date, only case studies have reported hypocalcemia in patients treated with the capreomycin-based regimen and the kanamycin-based regimen [21, 25, 26]. In accordance with these previous case reports, our study revealed a decrease in ionized serum calcium in both groups, and this decrease was statistically significant within the capreomycin group.…”

“…The incidence of severe hypokalemia was higher in the capreomycin-based group than in the kanamycin-based group. Two case reports by Holmes et al and Sharma and Sahay demonstrated hypomagnesemia in the MDR-TB patients who were treated with a capreomycin-based regimen [21, 25]. A study by Arnold et al found hypomagnesemia in some subjects within a capreomycin-based treatment group but found no evidence of hypomagnesemia in a kanamycin-based treatment group [24].…”

Transient Bartter-like syndrome in a child with extensively drug-resistant tuberculosis: Answers

“…Management of drug-induced acquired Bartter's-like syndrome condition is to withhold the offending agent and correct the electrolyte imbalance. Drugs like indomethacin, potassium-sparing diuretics, and aldosterone receptor antagonists have been used [9]. In our patient, capreomycin was withheld and parenteral electrolyte correction was given initially followed by oral replacement for 6-8 weeks.…”

Electrolyte and Acid-Base Disorders Triggered by Aminoglycoside or Colistin Therapy: A Systematic Review

“…The literature search process is summarized in Figure 1 . For the final analysis, we evaluated 46 reports [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] published between 1961 and 2020 in English (N = 45) and Spanish (N = 1). They had been reported from the following countries: United States of America (N = 12), India (N = 8), United Kingdom (N = 7), Turkey (N = 4), Ireland (N = 3), Greece, Israel, Taiwan (N = 2), Australia, Belgium, Canada, Croatia, Paraguay, and Spain (N = 1).…”