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Exacerbation of porphyria during treatment of pulmonary tuberculosis

G L Treece, C R Magnussen, J R Patterson

    The American Review of Respiratory Disease
    |February 1, 1976
    PubMed

    Insights

    Pyrazinamide, used to treat tuberculosis, can trigger acute intermittent porphyria attacks by increasing a key enzyme. This finding suggests pyrazinamide may worsen porphyria in susceptible patients.

    Area of Science:

    • Biochemistry
    • Pharmacology
    • Hepatology

    Background:

    • Acute intermittent porphyria (AIP) attacks complicated tuberculosis treatment in a patient.
    • The potential for drug-induced AIP exacerbations necessitates understanding drug mechanisms.

    Purpose of the Study:

    • To investigate the potential of antitubercular drugs to induce acute intermittent porphyria.
    • To assess the effect of various antitubercular drugs on (delta)-amino-levulinic acid synthetase activity in a rat liver model.

    Main Methods:

    • A rat liver model was used to measure (delta)-amino-levulinic acid synthetase activity.
    • The induction potential of several antitubercular drugs was evaluated.

    Main Results:

    • Pyrazinamide significantly induced (delta)-amino-levulinic acid synthetase activity.
    • Other antitubercular drugs showed minimal or no induction of the enzyme.

    Conclusions:

    • Pyrazinamide is implicated as a potential cause of AIP exacerbation in the patient.
    • Tuberculosis-related debility may have also aggravated the patient's latent porphyria.

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