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Pyrazinamide-induced granulomatous hepatitis

B Knobel1, G Buyanowsky, M Dan

  • 1Department of Medicine B, Edith Wolfson Medical Center, Holon, Israel.

Journal of Clinical Gastroenterology
|June 1, 1997
PubMed
Summary

Pyrazinamide, a tuberculosis drug, can cause noncaseating granulomatous hepatitis. This case report details a patient who developed liver damage and hyperuricemia after starting pyrazinamide, highlighting a rare drug-induced liver injury.

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Area of Science:

  • Hepatology
  • Pharmacology
  • Pathology

Background:

  • Noncaseating granulomatous hepatitis is a liver condition with diverse etiologies, often drug-induced.
  • Pyrazinamide is a first-line antituberculosis medication.
  • Drug-induced liver injury (DILI) represents a significant clinical challenge.

Observation:

  • A 52-year-old male presented with fever, chills, fatigue, liver damage, and hyperuricemia.
  • Symptoms emerged approximately four weeks after initiating pyrazinamide therapy for tuberculosis.
  • Liver biopsy revealed noncaseating epithelioid granulomas, indicative of granulomatous hepatitis.

Findings:

  • This case represents the first documented instance of granulomatous hepatitis associated with pyrazinamide.
  • The patient's liver function normalized following the discontinuation of pyrazinamide treatment.

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  • Pyrazinamide should be considered a potential cause of drug-induced granulomatous hepatitis.

    • Implications:

    • This finding expands the known spectrum of pyrazinamide-induced adverse effects.
    • Clinicians should maintain a high index of suspicion for pyrazinamide-induced liver injury in patients presenting with compatible symptoms.
    • Further research is warranted to elucidate the mechanisms underlying pyrazinamide hepatotoxicity.