Abstract
Syndrome of inappropriate antidiuretic hormone is the most common cause of hyponatremia in hospitalized patients. It is defined as retention of water, loss of sodium and inappropriately concentrated urine in euvolemic patients with normal renal and adrenal function. A 26-year old male was admitted due to weight loss and fever that he had experienced for the previous 1 month. The chest X-ray and CT scan of lung showed about 2.5×1.2 cm lymph node enlargement at the left hilum and multiple lymph node enlargements. Thoracoscopic biopsy revealed tuberculosis. During treatment with antituberculosis drugs, the serum sodium was 125 mEq/L, the serum osmolality was 263 mOsm/kg, the urine osmolality was 577 mOsm/kg, and the urine sodium concentration was 177 mEq/L. He was treated by fluid restriction and hypertonic saline infusion, but he did not improve. Brain CT scan showed tuberculous meningitis with hydrocephalus. He fully recovered after undergoing ventriculoperitoneal shunt. We report here on a case of inappropriate antidiuretic hormone syndrome complicated by tuberculous meningitis that was refractory to antituberculosis drugs.
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