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Isoniazid-induced Lupus: When the Cure Can Be Lethal.

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A rare case of drug-induced lupus, a serious side effect of isoniazid treatment for tuberculosis, is presented. Discontinuing isoniazid resolved the patient's severe symptoms, highlighting the importance of considering this diagnosis.

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Area of Science:

  • Internal Medicine
  • Rheumatology
  • Infectious Diseases

Background:

  • Tuberculosis treatment commonly involves isoniazid, but drug-induced side effects can occur.
  • Isoniazid-induced lupus is a rare but serious condition that can mimic active tuberculosis.
  • Early diagnosis and management are crucial for patient recovery.

Observation:

  • A 50-year-old female with a history of bone tuberculosis presented with persistent fever and back pain.
  • Despite extensive workup for disseminated tuberculosis, symptoms persisted, with elevated inflammatory markers and pleural effusion.
  • Positive lupus anticoagulant, antinuclear antibodies (ANA), and anti-histone antibodies suggested an autoimmune process.

Findings:

  • The patient's symptoms resolved after discontinuation of isoniazid, leading to a diagnosis of isoniazid-induced lupus.
  • This drug-induced lupus-like syndrome is rare, with an incidence less than 1%.
  • The case highlights diagnostic challenges due to the rarity and severity of symptoms.

Implications:

  • Clinicians should consider drug-induced lupus in patients on isoniazid presenting with unexplained systemic symptoms.
  • Prompt recognition and withdrawal of the offending drug are key to successful management.
  • This case underscores the importance of vigilant monitoring for adverse drug reactions during tuberculosis treatment.