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[Isoniazid-induced hepatic failure. Report of a case]
R M Pereira1, A T Tresoldi, G Hessel
1Departamento de Pediatria da Faculdade de Ciências Médicas, Universidade Estadual de Campinas. rmpereira@uol.com.br
Abstract:
Isoniazid and pyrazinamide are both well-known hepatotoxic drugs. When isoniazid is used, the hepatic lesion appears before than when pyrazinamide is used. This paper intends to relate a case of a 5-month-old patient who had lungs' and meningeal tuberculosis and who developed toxic hepatitis accomplished by hepatic failure while he was being treated with isoniazid, pyrazinamide and rifampicin. The clinic manifestations and the laboratory alterations were detected in the fifth day of treatment and the recovery was fast; and almost complete by the end of the first week, in which the use of isoniazid had been suspended. Although it was necessary to take the patient to the intensive care unit, he had a good recovery, without sequels.
Insights
Tuberculosis drugs isoniazid and pyrazinamide can cause liver damage. A 5-month-old infant developed severe toxic hepatitis and liver failure during treatment, recovering quickly after isoniazid was stopped.
Area of Science:
- Hepatology
- Pediatric Infectious Diseases
- Pharmacology
Background:
- Isoniazid and pyrazinamide are first-line antituberculosis drugs.
- Both isoniazid and pyrazinamide are known to cause drug-induced liver injury (DILI).
- Isoniazid-induced hepatotoxicity often manifests earlier than pyrazinamide-induced hepatotoxicity.
Observation:
- A 5-month-old infant with pulmonary and meningeal tuberculosis was treated with isoniazid, pyrazinamide, and rifampicin.
- The patient developed toxic hepatitis with hepatic failure on the fifth day of treatment.
- Clinical and laboratory signs of liver injury were observed.
Findings:
- Hepatotoxicity was attributed to the antituberculosis regimen, particularly isoniazid.
- Prompt cessation of isoniazid led to rapid clinical improvement and near-complete recovery within the first week.
- The patient required intensive care unit admission but experienced a good recovery without sequelae.
Implications:
- This case highlights the potential for severe hepatotoxicity in infants treated with standard antituberculosis drugs.
- Early recognition and prompt management, including drug withdrawal, are crucial for favorable outcomes in pediatric DILI.
- Close monitoring for liver function is essential during antituberculosis therapy in young children.