Immunoallergic Hepatitis Induced by Antitubercular Drug: A Case Report

TL;DR

A 42-year-old tuberculosis patient developed immunoallergic hepatitis from antitubercular drugs but recovered after treatment adjustments.

Contribution

This case report presents a successful management strategy for immunoallergic hepatitis caused by antitubercular drugs.

Findings

Hepatic cytolysis occurred five days after starting anti-bacillary treatment.

Discontinuation of treatment led to rapid improvement in liver function.

Rifampicin desensitization was successfully carried out without complications.

Abstract

Antitubercular treatment is associated with numerous adverse effects, among which immunoallergic reactions present a significant challenge in management. These reactions may sometimes lead to the discontinuation of one or more antitubercular drugs, potentially compromising the patient's recovery. We report the case of a 42-year-old patient, followed for pleuropulmonary tuberculosis, diagnosed clinically, and put on anti-bacillary treatment. The evolution was marked by the onset of hepatic cytolysis, revealed by vomiting that occurred five days later. The diagnosis of immuno-allergic hepatitis was based on the delay in the onset of symptoms and the rapid improvement in liver function after discontinuation of anti-bacillary treatment. After normalization of liver function tests, each drug was reintroduced progressively over three days, with close monitoring for cytolysis. Ethambutol, pyrazinamide, and isoniazid, in that order, were successfully introduced. Rifampicin desensitization was carried out and was uneventful.

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