Anti-tuberculosis drug-induced liver injury

What you need to knowPatients may not recognise or report early symptoms of anti-tuberculosis drug-induced liver injury (DILI) due to their non-specific nature and overlap with symptoms arising from active tuberculosisAfter recovery from an initial DILI event, the same anti-tuberculosis drugs may be safely reintroduced in 80-90% of patients without recurrence of DILI; a phenomenon known as hepatic adaptationA 34 year old woman with pulmonary tuberculosis started first-line anti-tuberculosis therapy comprising rifampicin, isoniazid, pyrazinamide, and ethambutol. Two weeks into treatment, she complained of nausea and dark discoloration of urine. Liver enzymes and bilirubin (normal at baseline) were raised, with levels of bilirubin three times above the upper limit of normal, alanine aminotransferase four times above, and alkaline phosphatase two times above. A diagnosis of anti-tuberculosis drug-induced liver injury (DILI) was made, and all her anti-tuberculosis drugs were stopped. Over a period of 10 days, her DILI related symptoms resolved and…
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