Severe Acute Renal Failure Due to Tubulointerstitial Nephritis, Pancreatitis, and Hyperthyroidism in a Patient During Rifampicin Therapy Saime Paydas, MD Mustafa Balal, MD Ibrahim Karayaylali, MD Neslihan Seyrek, MD Department of Nephrology Cukurova University School of Medicine Balcali, Adana, Turkey ABSTRACT It is well known that rifampicin can cause nephrotoxicity. Rifampicin-related pan- creatitis and hyperthyroidism are rarely reported in the same patient in the pres- ence of tubulointerstitial nephritis. Reported herein is the medical management of a patient with hemolytic anemia, acute renal failure, pancreatitis, and hyperthy- roidism during with rifampicin therapy. A 50-year-old man was admitted to the hospital owing to abdominal colic and acute renal failure. He was treated with 2 courses of tetracycline-rifampicin for brucellosis 3 weeks and 4 months prior to admission. Physical examination showed blood pressure of 130/70 mm Hg, pul- monary crackles, and edema. Laboratory findings are detailed in the case report. Findings of abdominal ultrasonography suggested edematose pancreatitis and thy- roid ultrasonography showed several solid nodules. Renal biopsy showed tubu- lointerstitial nephritis. Although rifampicin-related tubulointerstitial nephritis and acute renal failure are not uncommon during rifampicin therapy, the convergence of hyperthyroidism, pancreatitis, tubulointerstitial nephritis, and acute renal fail- ure rarely presents in the same patient. Although pancreatitis, tubulointerstitial nephritis, and acute renal failure were ameliorated with corticoid therapy within 2 months, hyperthyroidism continued and required antithyroid therapy. In con- clusion, rifampicin may trigger hyperthyroidism in patients with goiter. Keywords: hyperthyroidism; pancreatitis; renal failure; rifampicin; tubulointerstitial nephritis 241 Advances in Therapy ® Volume 22 No. 3 May/June 2005 Address reprint requests to Dr. Saime Paydas Cukurova University School of Medicine Department of Internal Medicine 01330 Adana, Turkey © 2005 Health Communications Inc Transmission and reproduction of this material in whole or part without prior written approval are prohibited. 0784