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Acute liver failure caused by isoniazid in a child receiving carbamazepine
F E Berkowitz1, S L Henderson, N Fajman
1Department of Pediatrics, Emory University School of Medicine, and Pharmacy, Egleston Children's Hospital, Atlanta, Georgia 30303, USA.
Insights
A child developed acute liver failure after starting tuberculosis medication. Early recognition of isoniazid-induced liver injury is crucial, especially with concurrent seizure medications.
Area of Science:
- Hepatology
- Pediatric Pharmacology
- Infectious Disease Management
Background:
- Tuberculosis (TB) treatment commonly involves a multi-drug regimen.
- Isoniazid is a first-line anti-TB drug but carries a risk of hepatotoxicity.
- Concurrent medications can influence drug metabolism and toxicity profiles.
Observation:
- A 10-year-old boy on carbamazepine for seizures was initiated on a four-drug TB regimen (isoniazid, rifampin, pyrazinamide, ethambutol).
- Within four days, the patient developed acute liver failure.
- Isoniazid-induced liver disease was diagnosed.
Findings:
- The patient experienced rapid onset of severe hepatotoxicity.
- The co-administration of carbamazepine and rifampin may have potentiated isoniazid's liver toxicity.
- This case highlights a potential drug interaction exacerbating isoniazid hepatotoxicity.
Implications:
- Emphasizes the need for vigilant monitoring of liver function in pediatric patients receiving isoniazid, particularly those on other potentially hepatotoxic or enzyme-inducing medications.
- Underscores the importance of early diagnosis and intervention for isoniazid-induced liver disease.
- Suggests a need for further investigation into drug interactions involving first-line TB agents and common antiepileptic drugs.
Abstract:
We report a case of a 10-year-old boy, being treated for seizures with carbamazepine, who developed acute liver failure within four days of initiation of therapy for suspected tuberculosis with isoniazid, rifampin, pyrazinamide, and ethambutol. Isoniazid-induced liver disease was diagnosed. The likely role of carbamazepine and rifampin in potentiating the hepatotoxicity of isoniazid, and the importance of early recognition of isoniazid-induced liver disease, are discussed.