jtitle=Reactions Weekly,Reactions Weekly (2019)

摘要：

S Ethambutol/isoniazid/rifampicin Fulminant hepatitis: case report A 53-year-old man developed fulminant hepatitis during treatment with ethambutol, isoniazid and rifampicin for tuberculosis meningoencephalitis. The man was admitted to hospital with altered sensorium for 1 day, grade IV breathlessness, decreased responsiveness and abdominal distension for the past 2 days. Fifteen days before the admission, he had started receiving isoniazid 300mg, rifampicin 450mg, ethambutol 800mg and unspecified steroids for tuberculosis meningoencephalitis. After few days of continuous therapy, he developed symptoms of malaise, epigastric pain with pale skin but his anti-tuberculosis therapy (ATT) was continued. At the time of admission, he was still on ATT therapy. Three days after admission, he developed signs of Jaundice with yellowish appearance of sclera. Liver parameters were as follows: AST 1580 U/L, ALT 1219 U/L, ALP 135 U/L, total bilirubin 239 mol/L and total protein 85 g/L. The CT scan of the chest showed pleural thickening on the right side, cardiomegaly, and patchy air space opacity noted in apical, posterior and anterior segments of the right lobe, basal segments of right lower lobe and basal segment of the left lower lobe. Ground glass opacity was seen in superior segment of the right lower lobe and left upper lobe. Abdominal examination showed epigastric tenderness. Elevations of prolonged prothrombin time, hyperbilirubinemia, increased hepatocellular enzymes and hyperammonemia were noted. Based on these findings, he was diagnosed with fulminant hepatitis secondary to ATT. The man was treatment with mannitol, dexamethasone, phenytoin, deriphylline, ceftriazone and a hepatic diet. He received plasma substitutes and vitamin K in order to correct prolonged INR. Isoniazid and rifampicin were stopped. Ethambutol was continued and streptomycin was added in order to treat the meningoencephalitis condition. After two days, laboratorial examinations revealed slight improvement in his hepatic function with resolving symptoms. Author comment: "Almost all the CAT I ATT drugs are metabolized by the liver and when the therapy lasts for a long time there are increased chances of hepatotoxicity and liver injuries."

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