title: Pancreatic insufficiency due to antituberculous therapy.
abstract: OBJECTIVE
  To describe a case of chronic pancreatic insufficiency related to antituberculous therapy.
  
  
  METHODS
  A 57-year-old man developed rash, fever, and hepatitis (aspartate aminotransferase 369 IU/L, alanine aminotransferase 506 IU/L), 6 weeks after starting isoniazid, rifampin, ethambutol, and pyrazinamide. He also developed severe metabolic acidosis secondary to diabetic ketoacidosis and lactic acidosis (serum bicarbonate 7 mEq/L, glucose 1778 mg/dL, and lactate 4.0 mEq/L). Acute pancreatitis was diagnosed on the basis of a mildly elevated amylase concentration (392 U/L) and radiologic evidence of pancreatic inflammation. He developed pancreatic insufficiency with steatorrhea and an abnormal secretin test. He continues to require pancreatic enzyme replacement and insulin therapy. Rechallenge was not performed.
  
  
  CONCLUSIONS
  Hypersensitivity syndromes have been reported for various drug therapies, including antituberculous agents. Hypersensitivity syndrome reactions are characterized by fever, rash, and internal organ involvement. Rifampin has been reported to cause acute pancreatitis in up to 2.7% of patients. Drug-induced chronic pancreatitis, however, is reported to be extremely rare. This is the first reported case of chronic pancreatic insufficiency occurring in the setting of a hypersensitivity syndrome reaction to antituberculous drugs.
  
  
  CONCLUSIONS
  Chronic pancreatic insufficiency should be considered as a possible long-term sequelae of a hypersensitivity syndrome reaction to antituberculous therapy.
authors.affiliation: Department of Medicine, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
authors.forename: B A
authors.initials: BA
authors.lastname: Liu
authors.forename: S R
authors.initials: SR
authors.lastname: Knowles
authors.forename: L B
authors.initials: LB
authors.lastname: Cohen
authors.forename: M R
authors.initials: MR
authors.lastname: Werb
authors.forename: N H
authors.initials: NH
authors.lastname: Shear
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002908:Chronic Disease; D004342:Drug Hypersensitivity / Q000209:etiology*; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010188:Exocrine Pancreatic Insufficiency / Q000139:chemically induced*; D006801:Humans; D007538:Isoniazid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011718:Pyrazinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin