A Case of Pyrazinamide Induced Fulminant Hepatic Failure.

Moon, Dae Sung; Jang, Tae Won; Oak, Chul Ho; Jung, Maan Hong; Yoo, Chan Hui; Song, Jun Young; Kim, Sung Eun; Kim, Ja Kyung; Jang, Lee La; Lee, Eun Young; Jung, Gyu Sik

doi:2007.63.5.435

Tuberc Respir Dis > Volume 63(5); 2007 > Article

Case Report

Tuberculosis and Respiratory Diseases 2007;63(5):435-439.
DOI: https://doi.org/10.4046/trd.2007.63.5.435 Published online November 1, 2007.

A Case of Pyrazinamide Induced Fulminant Hepatic Failure.

Dae Sung Moon, Tae Won Jang, Chul Ho Oak, Maan Hong Jung, Chan Hui Yoo, Jun Young Song, Sung Eun Kim, Ja Kyung Kim, Lee La Jang, Eun Young Lee, Gyu Sik Jung

¹Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea. jangtw@ns.kosinmed.or.kr
²Department of Radiology, College of Medicine, Kosin University, Busan, Korea.

Abstract

Standard antituberculous therapy, including isoniazid (INH), rifampin, ethambutol, and pyrazinamide (PZA), is widely used to treat active tuberculosis. The most important side effect is hepatotoxicity. In a standard four-drug regimen, PZA was the most common cause of drug-induced hepatitis and was dose-related. The incidence of drug-induced hepatitis is high at doses of 40~70 mg/kg per day but has fallen significantly since the recommended dose was reduced. Liver toxicity induced by PZA is rare at doses of 25 mg/kg per day or less. PZA-induced fulminant hepatic failure is also rare but fatal. We report a case of fulminant hepatic failure caused by a re-challenge of PZA.

Key Words: Drug induced hepatitis, Fulminant hepatic failure, Pyrazinamide