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Fatal Isoniazid Hepatotoxicity in the Deployed Environment
Daniel J Cybulski1, Brian K White1
1Craig Joint Theater Hospital, 455th Expeditionary Medical Group, Bagram, AE 09354, Afghanistan.
Military Medicine
|October 31, 2020
Summary
Latent tuberculosis infection treatment with isoniazid can cause fatal liver injury in deployed personnel. This case highlights the risks of using isoniazid in expeditionary settings, questioning its forward deployment suitability.
Area of Science:
- Military Medicine
- Infectious Disease Management
- Pharmacovigilance
Background:
- Predeployment medical assessments aim to identify potential health issues challenging expeditionary medical resources.
- Current deployment standards do not disqualify latent tuberculosis infection or specifically list isoniazid as a disqualifying medication.
- Isoniazid is a known cause of drug-induced liver injury.
Observation:
- A case of fatal isoniazid-induced drug-induced liver injury occurred in a deployed individual.
- This event occurred despite standard predeployment screening protocols.
- The patient's latent tuberculosis infection was not a disqualifying condition.
Findings:
- Isoniazid, used for latent tuberculosis infection, poses a significant risk of severe hepatotoxicity.
- The risk of drug-induced liver injury from isoniazid may be underestimated in deployed settings.
- Fatal outcomes are possible even with routine medical surveillance.
Implications:
- Re-evaluation of the use of isoniazid for latent tuberculosis infection in forward deployed environments is warranted.
- Clinicians should carefully weigh the risks and benefits of isoniazid in resource-limited expeditionary settings.
- Enhanced monitoring for hepatotoxicity may be necessary for personnel on isoniazid during deployment.
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