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[A case of successful desensitization therapy for isoniazid-induced pneumonitis]

Yoriko Nishizawa1, Masahide Yasui, Chihiro Yamamori

  • 1Department of Respiratory Medicine, National Hospital Organization, Kanazawa Wakamatsu Hospital, Se 103-1 Wakamatsu-machi, Kanazawa, Ishikawa 920-1183, Japan.

Nihon Kokyuki Gakkai Zasshi = the Journal of the Japanese Respiratory Society
|September 11, 2004
PubMed

Insights

Isoniazid-induced pneumonitis is a rare adverse reaction during tuberculosis treatment. Successful drug desensitization was achieved in a patient with isoniazid-induced pneumonitis, offering a potential treatment option.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Clinical Pharmacology

Background:

  • Tuberculosis (TB) treatment commonly involves a multi-drug regimen including isoniazid (INH).
  • Adverse drug reactions can complicate TB therapy, necessitating careful monitoring and diagnosis.
  • Drug-induced pneumonitis is a recognized, albeit uncommon, complication of antitubercular medications.

Observation:

  • A 65-year-old male developed fever and interstitial pneumonia on day 14 of anti-TB treatment.
  • Symptoms resolved upon drug withdrawal, but rechallenge and drug lymphocyte stimulation tests implicated isoniazid (INH).
  • A positive INH provocation test confirmed INH-induced pneumonitis.

Findings:

  • Drug lymphocyte stimulation tests for rifampicin (RFP), ethambutol (EB), and pyrazinamide (PZA) were negative.
  • A subsequent INH provocation test was positive, confirming isoniazid-induced pneumonitis.
  • Successful two-week isoniazid desensitization was achieved without adverse events.

Implications:

  • Physicians should consider drug-induced pneumonitis in TB patients presenting with new pulmonary infiltrates during treatment.
  • Isoniazid desensitization may be a viable strategy for managing INH-induced pneumonitis, even in cases previously unreported.
  • Awareness of both paradoxical reactions and drug-induced pneumonitis is crucial for optimal TB patient management.

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