Addisonian pigmentation of tubercular etiology-A case report

Addisonian pigmentation is defined as hyperpigmentation of both exposed and unexposed parts of the body and it typically occurs in primary adrenal insufficiency. We hereby report a case of a 15 year old boy who presented with progressive hyperpigmentation of the face, trunk, chest, abdomen and extremities which was more accentuated over the sun exposed areas. He also had` pigmentation of nails, oral and genital mucosa, palms and soles with accentuation over palmar creases. Routine blood investigations were found to be normal. His serum electrolytes showed hyponatremia and hyperkalemia with evidence of hypocortisolemia and` increased serum ACTH. Chest x-ray was suggestive of pulmonary tuberculosis, sputum AFB was positive and Mantoux reaction was strongly positive. CT scan showed bilateral adrenal calcification. All these investigations confirmed primary adrenal insufficiency due to tuberculosis and ATT was initiated along with steroid replacement therapy.