Hepatotoxicity Induced by Anti-Tubercular Drugs Therapy: A Case Report

Abstract

Anti-tubercular therapy induced liver injury (ATTILI) is the most important risk for the past many years. Many pre-existing factors and conditions like persisting liver injury, female gender, alcohol abuse etc. are important risk factors for the ATT induce liver injury. I read many case reports and literature review for the drugs induce liver injury, and concluded the results, ATT drugs are the most responsible for the liver injury during the therapy periods. The present case was 42-year-old male patient and known case of pulmonary tuberculosis, patients were on the ATT drugs therapy in the last 14 days. After few days of therapy, he produced signs of vomiting (multiple episode), fever (high grade), abdomen pain, coughing, loss of appetite, epigastric discomforts & generalized weakness. On general examination the patient was found to produce signs of Jaundice with yellowish appearance of the sclera. Pulmonologist had firstly withdrawal the anti-tubercular drugs therapy and started the modified anti-tubercular drugs therapy. As a Clinical pharmacist we advise the patients & patients relatives, proper monitoring of liver and renal function test should also be carried out by the health care professional specialist from time to time in order to avoid critical situations.
 Keywords: Anti-tubercular therapy, Anti-tubercular therapy induced liver injury, Pulmonologist, Hepatotoxicity.

Rifampicin Induced Cutaneous Adverse Drug Reaction: A Case Report

“…[4,5] The clinical spectrum consists of Morbilliform (measles-like) Drug Eruption (MDE), commonly known as maculopapular eruption, Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), Drug Rash with Eosinophilia and Systemic Symptoms (DRESS syndrome), Lichenoid Drug Eruption (LDE), and Fixed Drug Eruptions (FDE). [2,3,4] In our case, careful observation and confirmation through the steps of stopping and restarting medication clearly point to rifampicin as the cause of the skin reactions. This differs from the usual pattern from current literature10, 2 and highlights the special nature of our case compared to what is typically seen in existing studies.…”

“…This could be attributed to factors such as an enhanced rate of tuberculosis detection, improved treatment adherence, early detection of cutaneous adverse drug reactions (CADRs), or potentially the increased dosage of drugs administered daily compared to the previous thriceweekly regimen. [2] The spectrum of tuberculosis-associated ADR ranges from minor to life-threatening, including delayed-type Cutaneous Adverse Drug Reactions (CADR), immediate-type hypersensitivity reactions, drug-induced liver injury, nausea and vomiting, arthralgia, peripheral neuropathy, vertigo, and psychosis [4] .The severity of clinical presentations associated with Drug Hypersensitivity Reactions (DHRs) can range from mild, such as urticaria, to severe conditions like Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome or Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) Adverse Drug Reactions (ADRs). Fixed Drug Eruption, including Drug Hypersensitivity Reactions (DHRs) to highly effective firstline anti-TB drugs, carries significance due to its potential to restrict the use of these medications, leading to increased loss to follow-up, treatment failure, and relapse [2] .…”

“…According to the World Health Organization (WHO), a Drug Hypersensitivity Reaction (DHR) is classified as a significant adverse drug reaction (ADR) characterized by "objectively reproducible symptoms or signs that arise following exposure to a specific stimulus at a dose that is typically well-tolerated by individuals without hypersensitivity" [2] Presently, a treatment regimen for drug-sensitive tuberculosis involves a combination of four drugs, including Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol. Managing adverse skin reactions to these anti-tubercular drugs poses a dilemma.…”

“…On the other side, persisting with the treatment may result in the ongoing or worsening of the adverse drug reaction. [2,3] Mild liver dysfunction stands out as the most frequent adverse reaction induced by first-line anti-tuberculosis drugs, with severe effects such as liver failure or mortality being exceedingly rare. Additionally, these drugs may elicit other adverse reactions, including skin rashes localized or covering the entire body, with the maculopapular type being the most prevalent.…”

Clinical Pharmacist Interventions on Miliary Koch’s Patient With Antitubercular Therapy-Induced Hepatotoxicity and Psychosis: A Rare Case Report

“…Hematological spreading of tuberculosis bacteria in the lungs is also known as miliary tuberculosis. Antitubercular drug therapy is generally used in the tuberculosis, this therapy is also known as directly observed treatment short course (DOTS) therapy [1][2][3]. Antitubercular treatment (ATT) drugs therapy is mainly responsible for the irreversible/ reversible hepatotoxicity, hepatitis, ototoxicity, neuromuscular blockage, neuropathy, ophthalmopathy, thrombocytopenia, and nephrotoxicity.…”