Disseminated tuberculosis following immunosuppressive therapy for nephrotic syndrome

Over 80% cases of nephrotic syndrome (NS) in children are due to minimal change disease and most respond to steroid therapy. Steroid sensitive NS rarely progresses to end stage renal failure, over 80% entering spontaneous long term remission in later childhood. In contrast, steroid resistant and refractory NS have an unfavourable outcome often progressing to end stage renal failure. Infection is a universal concern in patients receiving cytotoxic or immunosuppressive therapy. Concomitant glucocorticoid therapy adds to this problem and the risk of infection with cytomegalovirus, Pneumocystis carinii, and varicella zoster is always present. It is well known that severe attack of measles can re-activate tuberculosis and this case report describes its reactivation following immunosuppressive therapy for NS.