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Pancreatic insufficiency due to antituberculous therapy
B A Liu1, S R Knowles, L B Cohen
1Department of Medicine, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
The Annals of Pharmacotherapy
|June 1, 1997
Summary
Antituberculous therapy can rarely cause chronic pancreatic insufficiency. This case highlights a hypersensitivity reaction to tuberculosis drugs leading to long-term pancreatic dysfunction, necessitating enzyme replacement.
Area of Science:
- Hepatology
- Gastroenterology
- Pharmacology
Background:
- Antituberculous therapy is crucial for treating tuberculosis but can be associated with adverse drug reactions.
- Hypersensitivity syndromes are known complications of various medications, including antituberculous agents, presenting with systemic symptoms and organ involvement.
Observation:
- A 57-year-old male developed rash, fever, and hepatitis 6 weeks after initiating isoniazid, rifampin, ethambutol, and pyrazinamide.
- The patient presented with severe metabolic acidosis, diabetic ketoacidosis, lactic acidosis, and acute pancreatitis, confirmed by elevated amylase and imaging.
- He subsequently developed chronic pancreatic insufficiency, evidenced by steatorrhea and an abnormal secretin test.
Findings:
- This case represents the first documented instance of chronic pancreatic insufficiency developing as a consequence of a hypersensitivity syndrome reaction to antituberculous drugs.
- Rifampin is a known cause of acute pancreatitis, but drug-induced chronic pancreatitis is exceptionally rare.
Implications:
- Chronic pancreatic insufficiency should be considered a potential long-term sequela of hypersensitivity reactions to antituberculous therapy.
- This finding underscores the importance of vigilant monitoring for rare but severe adverse effects of antituberculous medications.