Grand Rounds--Hammersmith Hospital: Persistent fever in pulmonary tuberculosis

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Abstract
Drug malabsorption should be considered Malabsorption of rifampicin and other antituberculous drugs is becoming an increasing problem, particularly in HIV positive patients with tuberculosis. Its occurrence presents a formidable challenge to doctors as persistently low drug doses can result in multiple drug resistance. We describe the case of an HIV negative man with pulmonary tuberculosis and a persistent fever, despite two months treatment with rifampicin, isoniazid, and pyrazinamide. We discuss possible causes of this fever, including cytokine release, drug induced fever, drug resistance, and drug malabsorption. The case presented here highlights the difficulties in detecting the malabsorption.