Fulminant Hepatitis Secondary to Anti-tuberculosis Drug-induced Hepatotoxicity Complication, Its Prevention Strategies and Management: A Case Report

Abstract

Aim: Tuberculosis remains a public health problem around the world. Hepatotoxicity is a serious side effect of anti-tuberculosis treatment. Fulminant hepatitis is a rare form but considered very serious outside of liver transplantation. It can occur several weeks or months after the start of treatment. Presentation of Case: We report the case of a 34-year-old single male patient treated for pleural tuberculosis in whom fulminant hepatitis appeared after four months of treatment with Isoniazid and Rifampicin. Despite a treatment in intensive care unit He had a fatal outcome because of lack of liver transplantation. Discussion: Hepatotoxicity varies from biological hepatitis to fulminant hepatitis. Application of personalized strategy of genetic analysis and pharmacological drug monitoring to optimize treatment is the most safe to avoid antituberculosis drug induced hepatotoxicity but not available in all healthcare centers of developing countries. There was any change of anti-tuberculosis protocol because of the risk of bacterial resistance. The protocol includes association between several medicines potentially toxics for a long duration. For some moderate forms of   tuberculosis (nodals, pleural), it’s necessary to ask if duration of antiviotherapy can be reduced. Conclusion: Prevention of hepatotoxicity starts with identifying risk factors, regular clinical and biological assessment and informing patients of symptom that can indicate toxicity to react early.