초록
특이 병력이 없는 56세 남자가 폐결핵 치료 6주 후 전신 부종과 신손상으로 왔고 신장 조직 검사를 통해 면역음성 반월상 사구체신염으로 진단하였다. 폐결핵을 동반한 상태이므로 세포독성 약물은 사용하지 않았으며 약물 중단과 고용량 메칠프레드니솔론 치료를 통해 신기능 회복을 유도하였고, 리팜핀을 제외한 항결핵 약물로서 안정적으로 폐결핵을 치료할 수 있었다.
A 56-year-old male with pulmonary tuberculosis was admitted to our hospital for evaluation of generalized edema. He began antituberculosis treatment with rifampin, isoniazid, ethambutol, and pyrazinamide. He experienced abnormal increments in weight and serum creatinine after 6 weeks. All serological findings, including anti-neutrophil cytoplasmic antibodies (ANCA), were negative. Rifampin was stopped because it might have caused the increase in creatinine. Renal biopsy was consistent with pauci-immune crescentic glomerulonephritis (CrGN). His renal function was improved by high-dose steroid treatment. Rifampin-induced, ANCA-negative pauci-immune CrGN is very rare; most cases of rifampin-induced acute renal failure are due to acute tubulointerstitial nephritis. We present here a case of rifampin-induced CrGN and pulmonary tuberculosis successfully treated with high-dose steroids and antituberculosis medications, excluding rifampin.