Drug-Induced Fulminant Hepatitis in a Child Treated for Latent Multidrug-Resistant Tuberculosis With Dual Therapy Combining Pyrazinamide and Levofloxacin

Abstract

We report the case of a 10-year-old child treated for latent tuberculosis infection (LTBI) with pyrazinamide (PZA) and levofloxacin after contact with a smear-positive multidrug-resistant tuberculosis adult. Over the course of the treatment, the patient developed a drug-induced fulminant hepatitis attributed to the combination of PZA and levofloxacin. This case highlights the hepatotoxicity of the association of second-line anti-TB treatment in children.

The paradigm shift in the approach to management of latent tuberculosis infection in high tuberculosis burden countries

“…The rate of permanent withdrawal of the FQ due to side effects ranges from 6% to 33% of all treated patients [57]. Drug-induced fulminant hepatitis has been reported in a child for LTBI with pyrazinamide and levofloxacin, after contact with an adult with multidrugresistant TB [62].…”

What Is Uncommon Can Be Critical: A Case of Quinolone-Induced Acute Liver Failure

“…Numerous reports of ALF have been associated with fluoroquinolones as Adikwu and Deo explain [3]. However, there are only a few cases described in the literature linking ALF to levofloxacin [4][5][6][7][8]. The following text details a case of a patient who developed ALF following IV infusion of levofloxacin.…”