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Unusual Recurrence of Antituberculosis Drug-Induced Hepatotoxicity in Children: A Case Series
Heda Melinda Nataprawira1, Almira Aliyannissa1, Sindy A Febrianti1
1Department of Child Health, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
Abstract:
BACKGROUND Antituberculosis drug-induced hepatotoxicity (ADIH) is a possible adverse event of antitubercular treatment. There are still no official guidelines for ADIH management in children. Recurrent ADIH is infrequently reported. CASE REPORT In this article, we report 6 unusual cases of recurrent ADIH in children. Five children developed ADIH during the intensive phase. Streptomycin and ethambutol were given to those with tuberculosis meningitis, urinary tract tuberculosis, and one patient with pulmonary tuberculosis with HIV infection and cardiac comorbidities. Five patients experienced a second ADIH episode after reintroduction. One patient developed ADIH symptoms again before reaching a full dose of isoniazid. The patient with pulmonary tuberculosis, HIV infection, and dilated cardiomyopathy experienced secondary episodes of ADIH and received levofloxacin and ethambutol as additional drugs. CONCLUSIONS Recurrent ADIH is relatively uncommon in children but may be encountered in daily practice. Reintroduction of previous treatment regimens should be tailored individually. There is an urgent need for standardized guidelines for ADIH in children.
Insights
Recurrent antituberculosis drug-induced hepatotoxicity (ADIH) is uncommon in children but requires careful management. Individualized treatment is crucial, highlighting the need for standardized pediatric ADIH guidelines.
Area of Science:
- Pediatrics
- Hepatology
- Infectious Diseases
Background:
- Antituberculosis drug-induced hepatotoxicity (ADIH) is a known adverse event of tuberculosis treatment.
- Official management guidelines for pediatric ADIH are lacking.
- Recurrent ADIH in children is infrequently reported in medical literature.
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