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Updated: Aug 27, 2025

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
Published on: January 31, 2022
Pyrazinamide related prolonged drug-induced liver injury: A case report
Yeh-Chin Wang1, Kai-Hsiang Chen1, Yen-Lin Chen1
1Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Rationale:
Drug induced liver injury (DILI) is a common side effect causing treatment discontinuation during tuberculosis (TB) treatment, and pyrazinamide (PZA) usually leads to a delayed and prolonged abnormal liver function of the 4 standard anti-tuberculosis regimens. However, a prolonged hepatitis lasting more than 4 months is rarely reported.
Patient Concerns:
A 78-year-old man presented with general weakness and poor appetite on his seventh week of anti-TB treatment for tuberculosis lymphadenitis.
Diagnosis:
Drug induced liver injury, PZA-related. NAT2 slow acetylator phenotype was accidentally found during workup of DILI.
Intervention:
A liver biopsy was performed and PZA-related DILI was suspected. All anti-TB medications were therefore discontinued.
Outcome:
After withholding all anti-TB medications for 4 months, the elevations of aminotransferases and hyperbilirubinemia completely resolved. Anti-TB therapy was switched to ethambutol and levofloxacin for 15 months without adverse events. Long-term ultrasound follow-up was performed and cervical lymphadenopathy completely resolved.
Conclusion:
Our patient presents with PZA related prolonged DILI resolved after drug discontinuation for 4 months. NAT2 slow acetylator phenotype may be related to this condition through unknown mechanisms.
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